- Pipeline Health System, LLC (Toast, NC)
- Job Title: Utilization Review Registered Nurse - Behavioral Health Unit/FT/Days Job Summary: This Utilization Review (UR) Registered Nurse ... compassionate care to our patients. This position is responsible for utilization review , assessment of discharge planning needs and coordination of effective… more
- Novant Health (Winston Salem, NC)
- **Overview** The Utilization Review RN serves as a leader resource in the Utilization Review process. They collaborate with physicians and other members ... coordinates and conducts initial, concurrent, and retrospective medical necessity reviews. All Utilization Review activities are performed in accordance with the… more
- The Arora Group (Bethesda, MD)
- …guidelines. + The Contractor shall frequently collaborate with managers of the UBO, Utilization Review Registered Nurse (RN) and pre-certification ... Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in… more
- Health Advocates Network (Ashland, OR)
- … Review experience. * Pay Rate: $2,608 weekly * Specialty: Discharge Planning and Utilization Review Registered Nurse (RN) * Shift: Day * 13 ... School of Nursing * 2 years of experience as a Discharge Planning and Utilization Review Registered Nurse (RN) * American Heart Association BLS *… more
- LifePoint Health (Hancock, MI)
- …growth of our employees both professionally and personally. We are seeking a detail-oriented Utilization Review Registered Nurse to be responsible for ... testing along with determining medical necessity of patient while hospitalized. Our Utilization Review RN will be part of an excellent team of Case Management… more
- Ascension Health (Manhattan, KS)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Intermountain Health (Murray, UT)
- …Medicare, Medicaid, Marketplace Qualified Health Plans and commercial health plans. Utilization review behavior health professional proactively manage inpatient ... and outpatient utilization to assure that medical care is appropriate, efficient,...medical necessity, applies clinical expertise to assure appropriate benefit utilization , facilitates safe and efficient discharge planning and works… more
- Albany Medical Center (Albany, NY)
- …with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure and/or Compact State Licensure Upon Hire - required ... works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve… more
- Trinity Health (Springfield, MA)
- …determinations using screening criteria, and assists the physician, bedside Registered Nurse , ICC and Social Worker with utilization management and clinical ... **Shift:** Rotating Shift **Description:** Requires BSN At **Mercy Medical Center** the ** Utilization Review /Appeals & Denials** **RN** performs utilization … more
- Trinity Health (Syracuse, NY)
- …Shift **Description:** 12-day shifts. Emergency department experience preferred. **Position Purpose:** The Registered Nurse Utilization Review (UR), ... Clinical Care Manger (CCM) actively manages the utilization review process and patient progression from...to all patients in accordance with the New York Nurse Practice Act, National Standards of Practice, and Nursing… more
- Crouse Hospital (Syracuse, NY)
- Utilization Management Registered Nurse has well-developed knowledge and is proficient with standard Utilization Review processes. The Utilization ... + EDUCATION / CERTIFICATION / LICENSURE + Required: + Currently licensed as a Registered Professional Nurse in New York State. + Associates Degree + Preferred:… more
- Martin's Point Health Care (Portland, ME)
- …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use...and offerings. Education/Experience: + Unrestricted state license as a Registered Nurse required; BSN preferred. + 3+… more
- Independent Health (Buffalo, NY)
- …enjoying first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse (URN) performs clinical review ... Degree in Nursing required; Bachelor's degree preferred. Current, active, unrestricted, and licensed registered nurse (RN) required. + Two (2) years of clinical… more
- US Tech Solutions (Chicago, IL)
- …you have experience with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About ... + 3+ years of experience as an RN + Registered Nurse in state of residence +...and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1… more
- Travelers Insurance Company (Buffalo, NY)
- …**What Is the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for ... to the compensable injury and for adhering to multi-jurisdictional Utilization Review criteria. **What Will You Do?**...assigned state preferred. **What is a Must Have?** + Registered Nurse ; Licensed Practical Nurse … more
- MetroHealth (Cleveland, OH)
- …patient care by ensuring the appropriate level of care at the point of entry. The utilization review nurse will work on defined patient populations and is ... degree in Nursing (applies to placements after 1/1/2017). Current Registered Nurse License State of Ohio. Minimum...skills. Preferred: Two years of experience with case management, utilization review . Physical Demands: May need to… more
- US Tech Solutions (May, OK)
- …years of experience as an RN . 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization ... CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …and/or elective surgical cases preferred. Essential Qualifications * Current licensed LPN or Registered Nurse (RN) with state licensure. Must retain active and ... * Adaptive to a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- Humana (Salem, OR)
- …interpretation and independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review cases using ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the appropriate state,… more