Utilization Review Nurse Jobs

1000+ jobs

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Utilization Review Nurse to perform utilization/claims reviews with a focus on retrospective reviews. This position will report to the Health Services Utilization Review Manager. Primary duties: Review retrospective authorization requests/claims documentation within specified timeframes. Review authorization requ...

Alliant Health Solutions is nonprofit families of companies helping governmental agencies ensure that tax dollars are used appropriately in the administration of public sector programs. Alliant educates providers on best practices to improve quality of care, ensures appropriate utilization of services through prior authorization and medical review, and provides program surveillance to drive out wa...

Utilization Management for the assigned Care Management population. This position is designed to facilitate an effective process of the Mercy Care Management model; supporting quality patient care, safety and financial components; promoting integration of a seamless care model; assisting with patient throughput; collaborating to include coordination as evidenced by metrics, optimizing performance ...

RN or LVN Workers Compensation Utilization Review/ Case Managerneeded for aPermanentopportunity with Yoh's client for a Remote/Telephonic Location. Top Skills Should You Possess: - Registered Nurse or Licensed Vocational Nurse in State of CA (Active and in Good Standing) - Must have three to five (3-5) years clinical nursing experience required. - Must have three to five (3-5) years of Recent ...

A-Line Staffing Solutions is looking for RN / Registered Nurse / HEDIS / Chart Auditing / Utilization Review Must be willing to travel throughout Michigan Some overnight stays may be required Must have reliable transportation Will be tested for computer abilities Must have experience as RN / Registered Nurse / HEDIS / Chart Auditing / Utilization Review Benefits: A-Line Staffing now offers ...

Position Description: We are currently seeking a Nurse Reviewer/Telephonic Case Manager with a compact state RN license. Provision of comprehensive Utilization Management, incorporating the strategies of cost containment, appropriate utilization of services and Case Management in a cooperative effort with other parties which helps address the issues of access to quality healthcare services at an...

We have just received a great Utilization Review opportunity for RNs. This is a time sensitive position; we need 3 RNs to start immediately! Utilization Review experience is preferred, but not required. The client is requesting that you are proficient in electronic charting and a fast learner. We encourage new graduates to apply! Here is your chance to try something new and get out of the hospit...

POSITION SUMMARY The UM/UR Registered Nurse is responsible for overseeing the Utilization Management Program for Inpatient and Outpatient services. This includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients, oversees the response to requests for services and interfaces with managed care organi...

Description : As a part of the Tenet and Catholic Health Initiatives family, 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 c...

Judge Healthcare is actively seeking a qualified Utilization Review Registered Nurse for an opening with one of our best clients in the Syracuse NY area! Summary: Performs utilization review in accordance with all state and federal mandated regulations. Reviews member records and, using approved criteria and member benefit information, ensures appropriate and cost-effective healthcare services ...

Judge Healthcare is currently seeking a Utilization Review RN with one of our outstanding clients in the Indianapolis, IN area! This job will have the following responsibilities: Responsible for conducting timely reviews of all requests for services required to meet medical necessity criteria to include reviewing pre-certification for outpatient and inpatient services. Applying criteria to inpat...

Utilization Review /Discharge Planning RN Full time Niagara Falls Memorial Medical Center, the Greater Niagara region’s leading healthcare provider, is currently recruiting for a Utilization ReviewNurse for our Quality Management Department. Requirements include: Current NYS Registered Nurse and 3 years recent clinical experience with strong background in discharge planning and managed care pre...

The U.R. Nurse gathers demographic and clinical information on prospective, concurrent, and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity and assigns an appropriate length of stay. REQUIRED EDUCATION/TRAINING Must be currently licensed as a Registered Nurse in the state of employment with a minimum of 4 years clinical experience. Must be computer ...

Are you a Texas licensed Registered Nurse who would like to work a Monday through Friday daytime schedule (no weekends) in an office environment without giving up highly competitive salary and benefits? TML Intergovernmental Employee Benefits Pool is looking for an RN with current TX license to perform telephonic utilization review of specified health services. If you have prior utilization revie...

CenterPointe Hospital is committed to treating behavioral health patients with an unprecedented level of understanding, respect and compassion. A full time day shift position is available - working with Adolescents, Children and Adults. RN license is required as well as experience with managed care and other insurance carrier regulations is required; previous direct clinical experience in behavio...

Job Description: We are in need of a qualified and committed Telephonic Inpatient UR Nurse knowledgeable in Milliman and Interqual guidelines for a full-time position. Qualifications: - Active CA RN license - 2+ years of experience - Telephonic Case Management experience - Experience and knowledge with inpatient, UM, concurrent reviews - Knowledge of Medicare and Medi-Cal programs - Backgr...

Utilization Review Nurseneeded for acontract to hireopportunity with Yoh's client located inSanta Clara, CA. Top Skills Should You Possess: - Experience in Managed Care or Case Management - Knowledge of Medi-Cal & Medicare What You'll Be Doing: - Day-to-day utilization review for inpatient and outpatient activities, utilizing approved policies, standards, and clinical criteria - Proactively ...

The Utilization Review RN is responsible for prospective, retrospective and concurrent Utilization Review activities. He/She is a member of the Multidisciplinary Team, and monitors the documentation for accuracy and clinical compliance. Specific Job Duties Include: •Performs supervisor assigned and random clinical reviews on patient records ​•Works closely with center staff, providing feedback,...

Description: There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse you wi...

Description: There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse you wi...