Utilization Review Nurse Jobs

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149 Utilization Review Nurse jobs found on Monster.

Jobs 1 to 20 of 149
Utilization Review Nurse (RN or LPN) – Managed Care South Seattle, WA Job Summary: As a Utilization Review Nurse you will utilize your clinical skills to review and monitor members’ utilization of health care services with the goal of maintaining high quality cost-effective care for health plan members that are hospitalized in acute, skilled and long term care settings. You will telephonically ...
MHM Services and Centurion of Tennessee are proud to be the provider of medical services to the Tennessee Department of Corrections. We are currently seeking Utilization Review/Utilization Management Nurses to oversee the medical services requests and ensure the appropriate level of care at the facilities within the Tennessee Dept of Corrections. This position is based out of our Regional Office i...
Our client in South San Francisco is looking for a Utilization Review Nurse to join their team! Duties · Conduct on-site reviews at inpatient facilities, including acute care, and/or process authorization requests for various services including but not limited to: outpatient, rehabilitation and/or home health services. · Review authorization requests for out-of-network inpatient facilities. · ...
COMPANY DESCRIPTION Newport Academy is a gender-specific, comprehensive treatment program for adolescents suffering from mental health, behavioral health and substance abuse issues located in Litchfield County. The program combines the key elements essential in effectively treating adolescent girls and boys with substance abuse and other mental health disorders. As compared with adults, adolescen...
Wouldn’t it be nice to work for a company where the mission makes sense, the salaries are competitive, the company listens to the needs of the employees and the office is professional yet the dress is casual? Access Management Services is a health care services and support company serving Colorado Access and its subsidiaries. Colorado Access is a nonprofit health plan supporting the medical, beha...
COMPANY DESCRIPTION Newport Academy is a gender-specific, comprehensive treatment program for adolescents suffering from mental health, behavioral health and substance abuse issues located in Litchfield County. The program combines the key elements essential in effectively treating adolescent girls and boys with substance abuse and other mental health disorders. As compared with adults, adolescen...
What We Do: MCMC's success can be attributed to our diverse and talented work force.​ Our employees are the foundation of our business and are helping MCMC grow each year.​ Because of our tremendous growth, we are always in search of outstanding individuals.​ Workers' Compensation Utilization Review Nurse SUMMARY: Responsible for performing workers compensation utilization review for multiple ...
Job Title: Utilization Review Nurse Location: Philadelphia, PA Duties: Retrospective Utilization Review applying InterQual Acute Level of Care Criteria, CMS guidelines or other applicable guidelines for HH, PT, OT Performs post service utilization review applying InterQual Acute Level of Care criteria, CMS guidelines or other guidelines provided by Compnay. Communicates verbally and in writin...
Position Title: Utilization Review Nurse Baltimore, MD Reports To: Vice President, Health Services Department: Health Services Position Summary: The Utilization Review Nurse will support the clinical review operations needed to assist its membership. This position is a member of a team of nurses, physicians, pharmacists, and program coordinators. This role evaluates the efficiency, appropriat...
Description The Utilization Review Nurse oversees the authorization process to ensure that the member receives benefits in accordance with their coverage in a quality and cost effective manner. The goals of this position are to authorize only covered services that are medically necesary to appropriate physicians/vendors in a timely manner. Qualifications CA RN or LVN license Minimum of 3 years...
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 comm...
Lenox Hill Hospital 2200 Northern Boulevard, NY
Description As a Utilization Review Nurse you will review and coordinate prospective, concurrent and retrospective activities related to utilization. Monitor documentations for accuracy and clinical compliance. Organize and coordinate activities within the organization in accordance with standards of State and Federal regulations; and in accordance with accreditation and other guidelines. RESPON...
UMC Southern Nevada Las Vegas, NV, 89134
Position Summary Benefits Supplemental Questions Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with third party payer requirements. Duties include analyzing medical charts, determining whether care provided is within established parameters and determining whether denials of reimbursement should be appealed. Job Requirement: Education/Experie...
LogistiCare, Inc. Austin, TX, 78719
- Active state license: RN, LVN or LPN - Background within the EMT field - Utilization Review background preferred or at least 1 year recent clinical or administrative experience. - Exceptional interpersonal skills with excellent written and verbal skills - Knowledge of clinical UR and QA, Medicaid, Medicare guidelines and covered services - Broad knowledge of health care system including hospital...
Kingman Regional Kingman, AZ, 86402
KEY RESPONSIBILITIES: 1. The Utilization Review Nurse is responsible for conducting and coordinating medical necessity reviews for all Medicare, Medicaid, self-pay and other insured patients, upon admission and concurrently throughout the inpatient stay. 2. Evaluates medical information against nationally recognized criteria and determines necessity for admission, continued stay, appropriateness o...
Maxim Staffing Solutions’ is seeking experienced Psych Registered Nurses for multiple Utilization Review openings in the Chicago land area. These are full-time permanent positions with great benefits and competitive pay. The ideal candidates MUST have minimum of 3 plus years of RN experience with a background in PSYCH and/or substance abuse healthcare setting, including Utilization review experien...
Position Title: Utilization Review Nurse Baltimore, MD Reports To: Vice President, Health Services Department: Health Services Position Summary: The Utilization Review Nurse will support the clinical review operations needed to assist its membership. This position is a member of a team of nurses, physicians, pharmacists, and program coordinators. This role evaluates the efficiency, appropriat...
IASIS Healthcare LLC Phoenix, AZ
Qualifications Knowledge: • Knowledge of medical terminology • Medical Records and Coding • Interqual criteria • Knowledge of Medicare and Medicaid regulations and guidelines • ICD-9/ICD-10 (when applicable) • CPT Codes and HCPCS codes Skills: • Computer experience necessary • Effective time management skills • Effective interpersonal and communication skills Abilities: • Ability to u...
IASIS Healthcare LLC Phoenix, AZ
Qualifications High School Diploma or GED Associate's Degree or Bachelor's degree from an accredited Nursing School Previous UR/Discharge planning experience preferred Chart review experience helpful Previous Medicaid/Medicare experience preferred...
Tenet Healthcare Corporation Dallas, TX
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...

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