Utilization Review Nurse Jobs
UnitedHealth Group Multiple
Description: Position in this function include RN (with current licensure) who responsible for utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management). Performs reviews of current inpatient services. Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination....
Position Description: DUTIES & RESPONSIBILITIES: •Demonstrates necessary skills and knowledge of the Medicare Administrative Contractor (MAC) program. •Provides clinical review of additional documentation requests and denials. Includes clinical review that is reflective of the clinical status of the resident (or non-reflective) found in the medical record. Identifies trends of inadequate documenta...
UTILIZATION REVIEW NURSE This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information Salary Negotiable Graduate of accredited nursing program; BSN preferred.Current TX RN license; current CPR certificationRN, BSN; or RN with 6 years of clinical experience and UR experience; or RN, CCM with 4 years ex...
. Start your journey towards better work and a better life today! Join Adecco! We are searching for a Utilization Review Registered Nurse on a 12 month contract opportunity with a leading Insurance company in Dallas, TX 75244 Looking for a Utilization Review RN to perform Utilization Review of select workers' compensation cases, comparing treatment episodes to clinical criteria for certification o...
Job Description Registered Nurse/Utilization Review Specialist - PT - denials exp(Job Number: 01331-2300) Work Location: United States-Florida-West Palm Beach-West Palm Hospital - formerly Columbia Hospital Schedule: Part-time Description Utilization Review Specialist Part-time Days West Palm Hospital West Palm Beach, FL Facility Description: West Palm Hospital, located in the heart of West Palm B...
Description Description Conifer Health Solutions is a leading healthcare business process management services provider working to improve operational performance for more than 600 clients so they can support financial improvement, enhance the patient experience, and drive value-based performance. Through our revenue cycle management, patient communications, and value-based care solutions, we empow...
We are seeking experienced nursing professionals to work a 6-month contract assignment with a well-known hospital in the Detroit area. - Must have Utilization Review and Interqual experience in a clinical setting - Medical benefits and 401K available FOR MORE INFORMATION, PLEASE CONTACT ME AT: Alliston Brown Staffing Manager A-Line Staffing Solutions 877-782-3334, ext. 229 email@example.com...
Description: The Utilization Management Nurse is responsible for utilization management, utilization review, or concurrent review. The UM Nurse will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Get better informed to determine your fit into this positio...
About the Opportunity A healthcare provider is currently seeking an experienced RN to join their Utilization Management team. The qualified nursing professional chosen for this role will telephonically manage utilization for the orthopedic patient population of a commercial health plan, specifically focusing on a new pain management program. This is an excellent opportunity for an RN looking for a...
Description Description The Case Manager will assess admission necessity utilizing the IQ SI/IS criteria. Review date will be assigned. If treatment plan does not meet criteria, the UR nurse will refer case to attending physician. If no determination, the UR nurse will refer the case to the Medical Director. The Case Manager will perform the initial IQ and clinical review, within one working day o...
Description: Under the general direction of the Medical Management Director, the Utilization Management Nurse provides authorizations for hospital admissions, skilled nursing facilities, rehabilitation facilities, specialist providers, outpatient services and ancillary services such as home healthcare, durable medical equipments, orthotics/prosthetic devices, colostomy supplies and Infusion servic...
Description: Position Summary: Option to work from home after 90 days of Proven Performance the Medical Review Nurse conducts independent review, research and analysis of requests for retrospective medical necessity determination with concentration on prudent standards of best practice and clinical decision sets. Adherence to Health Plan benefits and Medicare Guidelines is required. Outstanding Cu...
Description Description IN AN EFFORT TO PROVIDE A MORE HEALTHY, SAFE AND SATISFYING ENVIRONMENT TO OUR EMPLOYEES, INDIVIDUALS TO WHOM JOB OFFERS ARE EXTENDED MAY UNDERGO NICOTINE TESTING AS A PART OF THE PRE-EMPLOYMENT PROCESS. Nurse Manager of Utilization Case Management Auditing, located out of our Dallas home office but with the ability to work remotely. Seeking a Nurse Manager of Case Manageme...
Mitchell International Any City
Mitchell International, Inc. is a leading provider of information and workflow solutions to the Property & Casualty Claims and Automotive Collision Repair industries. Founded in 1946, Mitchell has delivered advanced information and technology solutions to over 100,000 customers throughout North America, helping them to improve their business process performance. The company's comprehensive solutio...
Description: The Utilization and Case Management Float Nurse position is responsible for facilitation of Utilization Management including Referrals, Inpatient, Claims Review, and Case Management day to day processes. Daily assignment is dependent upon department need. The person in this position will replace staff that is temporarily absent due to vacations, illness, etc. This position requires si...
Description: Responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency in accordance with CMS coverage guidelines. The UM Nurse determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Generally work is self-directed and not prescri...
Description: Onsite Utilization Management Nurse Tired of working bedside care? Burned out from 12 hour shifts and weekends? Then consider joining a progressive, innovative company that will allow you to take your career to the next level! Working for UnitedHealth Group will provide you the opportunity to not only work alongside the best healthcare professionals out there, but will give you the sk...
Liberty Mutual Insurance “Helping people live safer, more secure lives” since 1912, Boston-based Liberty Mutual Insurance is a diversified global insurer and third largest property and casualty insurer in the U.S. based on A.M. Best Company’s report of 2010 net written premium. Liberty Mutual also ranks 82nd on the Fortune 100 list of largest corporations in the U.S. based on 2010 revenue. As of D...
CyberCoders Matching Great People with Great Companies Learn more about CyberCoders Utilization Management RN LVN La Habra, CA; Fullerton, CA Full-Time $70,000 - $95,000 Posted 5/24/2013 Frank Molina is recruiting for this position. Email your resume to Frank Apply Job Details RN LVN Oncology Utilization Management Nurse UM RN LVN M-F Dayshift Great opportunity for a truly gifted Registered Nurse...
Description: There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm) We are currently hiring for evening shifts (Noon-9 or 12:30 - 9) Monday through Friday...
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Undergraduate nursing programs?
Is an undergraduate nursing program really as hard as everyone says? I already have a Bachelor's degree, but it is not applicable to any specific career. I would like to go back to school for a degree...
RNs please answer my questions?
I just starting med school and LOVE it. I always wanted to be an RN, but i just hear so many bad things about the job. First of all are you really like a SLAVE? people just make it seem like your a wo...
Is anyone here a Nurse? Can you explain to me what your job is like, and whether you think it may su...
I like the idea of helping sick people, that seems like it would be very rewarding. I also like the idea of being on £20,000 per year! I have seen pictures on the internet of people with severed ar...
Benefits of being a pharmacist?
Hey guys. So i am planning for my career to be a pharmacist. I was wondering what the benefits of being a pharmacist. For example the health insurance, company car, etc... Thank you so much for answe...
Career Change but Not sorta...?
Try to make this short: -Im an LPN student basically in the first quarter. I have a 3.8 GPA -Im 24 and my previous work history since I was 18 has been in the Industrial field (factory work). Very g...
Healthcare Career Tools
$53,600.00 - $103,400.00
Typical Salary for Nurse Manager
Source: Monster.com Careerbenchmarking Tool
Education / Training
Source: Monster.com Careerbenchmarking Tool
Promotes and restores patients' health by developing day-to-day management and long-term planning of the patient care area; directing and developing staff; providing physical and psychological support for patients, friends, and families.
Rate of Growth
Size of Industry in 2006:
Source: Bureau of Labor Statistics, May 2006
Maintains patient confidence and protects operations by monitoring confidential information processing.
Maintains nursing supplies inventory by studying usage reports; identifying trends; anticipating needed supplies; approving requisitions and cost allocations.
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