Utilization Review Nurse Jobs

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1000+ Utilization Review Nurse jobs found on Monster.

Jobs 1 to 20 of 31813
Our Medical Group client is looking for an RN or LVN to conduct Utilization Reviews and Insurance reviews (In-patient) on busy Medical Campus in Los Angeles. Successful nurse will have an RN or LVN and understand INTERQUAL guidelines as a part of the job responsibilities. It is also important that candidates have insurance review as a part of their past experience. Good computer skill, EHR and w...
Judge Healthcare is currently seeking a Utilization Review RN. This job will have the following responsibilities: Conducts utilization management activities in accordance with Utilization Management policies and procedures. Responds to calls, conducts certification reviews, facilitates the discharge planning and referral process and coordinates denials with physician advisors for all assigned p...
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Nurse Case Manager (Grievance and Appeals) to be responsible for the facilitation and management of clinically oriented member grievances and appeals, and any clinically oriented claims issues. This position will investigate and resolve member and practitioner grievances and appeals within plan, regulatory and accre...
Utilization Review Nurse Medical Review Service is currently seeking an experienced Utilization Review Nurse to join their team of professionals in Ft. Lauderdale, FL. Job Summary: The Utilization Review Nurse will be responsible for reviewing patient accounts for medical necessity, manage denials and appeals on discharged accounts and conduct complete chart audits to research billing and docum...
RN – Director of Utilization Review - Case Management - Nurse – Staff RN Director of Utilization Review Registered Nurse, RN Salem, NH Here's an incredible opportunity for a highly motivated and experienced nurse to take on the role of Director of Utilization Review at a highly respected hospital located in New Hampshire! Director of Utilization Review - This is a full time, permanent positi...
Registered Nurse – RN – Case Manager – Care Manager – Utilization Review - Seattle, WA Come join our team! We are Seattle’s BEST and fastest growing not-for-profit healthcare system! · The Collaborative Health Action Team (CHAT) is a Care Management Division that is a cornerstone of our changing care delivery model. · The RN Case Manager (CM) is a critical member of the Care Team, focused on p...
Hi Are you seeking unparalleled growth in a “sky the limit environment? This UTILIZATION REVIEW NURSE position is calling your name. A UTILIZATION REVIEW NURSE is needed for a recognized industry leader, who invests heavily in internal technologies. Our clients is experiencing explosive growth in a billion dollar industry and continues and to receive industry awards and accolades as a pioneer in ...
Maxim Staffing Solutions is looking to bring on RN's for several full time contracts in Utilization Review. These are 13 week contracts and possible travel contract. We are looking for nurses with exceptional clinical skills, positive attitude, a strong work ethic, and who are team players. Our office stresses the importance of these qualities, and we are only looking to bring on the best nurses a...
Maxim Staffing Solutions is looking to bring on RN's for full time Utilization Review work. We are looking for nurses with exceptional clinical skills, positive attitude, a strong work ethic, and who are team players. Our office stresses the importance of these qualities, and we are only looking to bring on the best nurses. The Registered Nurse, as a professional practitioner employed by Maxim He...
Summary The RN Care Manager/UMRN is responsible for projecting and integrating the Mission and Core Values of the organization in the provision care management services to members of the AHF/AHFMCO Medicare and Medicaid health plans of Florida. Key responsibilities include leading the care needs of members which provides culturally and linguistically sensitive care management services to the HIV...
Job Description: Great opportunity for a Utilization Review Nurse Required Skills: ? Approves requests for medical services (inpatient, pre-certification and concurrent, and outpatient) based on available information, utilizing nationally accepted guidelines for utilization management (InterQual) as well as standard of care information and clinical judgment as appropriate. ? Requests clinical ...
Judge Healthcare is actively seeking a Utilization Review LPN. This position is located in Oklahoma City, OK. The right candidate must possess the following qualifications: Valid Oklahoma LPN Licensure Prior utilization review experience Associates Degree in Nursing Please send your MOST UP TO DATE resume to Liz at ***** or give Liz a call at (484)270-1809 Thank you so much!! Li...
RN/Case Manager Kelly Services has an exciting opportunity for an RN / Case Manager to come work with our client located in Eagan, MN. This is an exciting opportunity to work for a very large insurance company assisting them with keeping the wheels of the health care industry turning. Apply today! ROLES AND RESPONSIBILITIES: The RN / Case Manager is a critical component of the integrated Health...
CONTRACT Utilization Review Nurse (RN) - Hospital Washington, DC *** This is a Full Time, Benefits Available, CONTRACT opportunity, expected to several months, or longer! *** Your Job Summary: The Utilization Review Nurse is responsible for utilization management, utilization review, or concurrent/retrospective review of the patient’s care. The UR Nurse ensures appropriate level of care throug...
The Utilization Management (UM) Review Nurse (Inpatient or Outpatient) performs chart reviews to determine medical necessity of requested outpatient services or inpatient stays, while maintaining compliance with appropriate nursing standards and all regulatory requirements. Interfaces with medical directors, and both internal and external stakeholders, in regards to coverage for services, contract...
Network Medical Management Inc (NMM) is a growing Management Services Organization (MSO) based in Alhambra, California. The Company provides comprehensive management services to Independent Physicians Associations (IPA) and medical groups. The company currently has a great opportunity for an experienced Outpatient Utilization (UM) Review Nurse. ESSENTIAL DUTIES AND RESPONSIBILITIES: · Review & ...
Title/Unit: RN – Director Case Manager Shift: Days Recently recognized by Forbes Magazine as second best place to raise a family. Our Historic downtown has unique architecture, quaint shops and overall serenity. The cities tree lined streets invite residents and visitors to walk the same paths as those walked by George Washington and Jim Thorpe. Restored homes, manicured lawns, and flower boxe...
Title/Unit: RN Director Case Management Shift/Schedule: Days Exciting opportunity to join a strong cosmopolitan growing city in the California market. Facility/Description: This opportunity is for a small 230 bed comunity facility located in beautiful Southern California. This Direcotr will be responsible for leading the inpatient case management program, utilization management and discharge...
Company Confidential Metro Market, FL, 32835
Utilization Review Professional Psychiatric Hospital Corporation of Orlando (metro-west area) seeks an experienced professional to manage its Utilization Review Division. Major responsibilities include the supervisor of staff in the performance of clinical assessments, admission intake and medical record documentation, regular chart auditing and filing of appeals as necessary to maximize revenue ...
JOB DESCRIPTION Manager / Denials - Utilization Review / Registered Nurse MANAGER LEVEL POSITION- Valid RN License BSN preferred; Certification as a CPHQ, CCM, ACM or IQCI preferred 5 years experience in Ultization Management, denials management or related field Knowledge of hospital billing systems preferred. Knowledge of statistics, data collection, analysis and data presentation. Knowled...

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