- University of Washington (Seattle, WA)
- …) **UW Medical Center** has an outstanding opportunity for an **experienced Utilization Review Nurse (UM RN)** to join our ... Req #: 236354 Department: UW MEDICAL CENTER - UTILIZATION MANAGEMENT Job Location Detail: Position supports both...training + Active licensure to practice as a Registered Nurse in Washington State required by start date +… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW ... and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- Utilization Review Nurse (40 Hour) Office/On-site Recruitment # 250102-5612FP-001 Location Hartford, CT Date Opened 1/6/2025 12:00:00 AM Salary $78,480 - ... and Addiction Services ( DMHAS (https://portal.ct.gov/DMHAS/About-DMHAS/Agency/About-DMHAS) ) as a Utilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) !… more
- Humana (Columbus, OH)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are...of the appropriate courses of action. You will be part of a caring community at Humana. When you… more
- Glens Falls Hospital (Glens Falls, NY)
- …week, can be foundhere. **Job:** **Nursing - Case Management* **Title:** *RN - Utilization Review Nurse * **Location:** *NY-Glens Falls* **Requisition ID:** ... timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, or health ... more at UCLA Health. You will play a key part in promoting high-quality, cost-effective medical care by applying...in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely… more
- Cleveland Clinic (Weston, FL)
- …patient's hospital stay or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review , providing clinical ... Utilization Management Specialist Join Cleveland Clinic Weston Hospital's...and education all while consistently providing patient-centered healthcare. As part of Cleveland Clinic's Florida region, Weston Hospital is… more
- VNS Health (Manhattan, NY)
- …subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is ... CEU credits, and advancement opportunities What You Will Do + Conducts comprehensive review of all components related to requests for services which includes a… more
- Trinity Health (Syracuse, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The RN Utilization Management Nurse Coordinator is responsible for both concurrent and ... retrospective inpatient and outpatient services, in accordance with the utilization requirements and 3rd party payor contracts. The UM department is responsible for… more
- New York State Civil Service (Malone, NY)
- …of post-licensure clinical nursing experience of which one year was in utilization review and/or discharge planning.Substitution: a bachelor's degree in nursing ... Agency Corrections and Community Supervision, Department of Title Registered Nurse 3 - Utilization Per Diem -...Salary Range From $39.84 to $42.40 Hourly Employment Type Part -Time Part -time Percent 0% Appointment Type Temporary… more
- Katmai (Usaf Academy, CO)
- …expertise. + Review clinical information for concurrent reviews. + As part of the UMRN program, conduct ongoing availability, monitoring and oversight of ... need for inpatient/outpatient precertification. **ESSENTIAL DUTIES &** **RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to the… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in ... Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...status patients by working with physicians to ensure appropriate utilization . 9) Is part of the department's… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Manager of Utilization Review oversees a team of utilization review nurses and coordinators, ensuring compliance with clinical ... regulatory standards, and enhancing the overall utilization review process to optimize patient care...+ 3-5 years work experience in healthcare as a nurse required + 1-3 years work experience in Care… more
- Kelsey-Seybold Clinic (Houston, TX)
- **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to ... care services requiring authorization prior to services being rendered for members. The Utilization Review Specialist (LVN) serves as a liaison in reviewing… more
- Providence (Mission Hills, CA)
- **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records ... strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The … more
- Sutter Health (Sacramento, CA)
- …Graduate of an accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California OR CNS-Clinical Nurse Specialist + BLS-Basic Life ... Support OR PALS-Pediatric Advanced Life Support OR CNOR-Certified Perioperative Nurse OR NRP-Neonatal Resuscitation Provider **EXPERIENE AS TYPICALLY ACQUIRED IN:**… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Munson Healthcare (Traverse City, MI)
- …interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic work ... many opportunities for growth and development + Be a part of a team that nurtures a culture of...+ Minimum of three years clinical experience required. Previous utilization review and/or case management in a… more
- Prime Healthcare (Weslaco, TX)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/188814/registered- nurse -case-manager utilization ... offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference....to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,… more
- Ascension Health (Baltimore, MD)
- …salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes ... implement quality review programs and key performance indicators for all utilization review activities. + Interact with medical, nursing, and executive… more