Utilization Review Nurse Jobs

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146 Utilization Review Nurse jobs found on Monster.

Jobs 1 to 20 of 146
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...
Job Description: Great opportunity for a Utilization Review RN. 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 info...
Company: Yoh Utilization Review Nurse needed for a direct hire opportunity with Yoh's client located in Santa Clara, CA. The Big Picture - Top Skills You Should 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 cl...
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...
WellPoint is one of the nation's leading health benefits companies and a Fortune Top 50 company. At WellPoint, we are working together to transform health care with trusted and caring solutions. Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives, and to take your career further than you can imagine. There are 2 openings. They...
Healthcare Resolution Services has an immediate opening for a Telephone Advice Nurse. The ideal candidate can have Utilization Nurse Experience. This position is a temp position with one of our respected clients. This positions requires an active unrestricted Nevada Registered Nursing license. Additional Licenses in other states a plus. Provision of Telephone nursing advice utilizing a software s...
Company Confidential Baltimore, MD
Healthcare Company looking for an experienced Utilization Review RN to perform medical record review and prior auth reviews on hospital inpatient services. This candidate will perform reviews for a Payer who needs to provide authorizations, for specific services rendered. Required Skills & Experience: Knowledge of Milliman or Interqual criteria Current Licensed RN in the State of MD Strong att...
WellPoint is one of the nation's leading health benefits companies and a Fortune Top 50 company. At WellPoint, we are working together to transform health care with trusted and caring solutions. Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives, and to take your career further than you can imagine. The Utilization Review RN ...
Tracking Code 1161 Job Description Responsible for coordinating and conducting medical necessity reviews for all Medicare, Medicaid, self pay and all other payers, upon admission and concurrently throughout the inpatient admission. Responsible for the accurate and timely entry of information related to coordination of reviews into AS400, MIDAS, and all other appropriate systems. This position is...
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...
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...
Position Description: We are currently seeking a Nurse Reviewer/Telephonic Case Manager for the Anaheim, CA area. 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 afford...
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...
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 s...
SUMMARY: The Utilization Review Nurse is responsible for resolving preauthorization requests and medical claims issues to ensure that appropriate care has been or will be delivered to our members. ESSENTIAL DUTIES AND RESPONSIBILITIES: · Use evidence based guidelines and medical necessity criteria to review and resolve preauthorization requests and medical claims related issues. · Understand a...
Health Services for Children with Special Needs, Inc. in Washington, DC is currently seeking self-motivated candidates for a Utilization Review (UR) Nurse to focus on our inpatient members. The Utilization Review (UR) Nurse is responsible for the clinical review of pediatric and young adult members for all inpatient stays, homecare, outpatient rehabilitative therapy, durable medical equipment and ...
LifeBridge Health Baltimore, MD
Opportunity to telecommute/work from home; full-time and part-time positions available. Utilization Review experience is required. Conducts chart review for clinical, financial and resource utilization information. Provides intervention and coordination for the plan of care to promote efficient use of resources, decrease denial of payment, and decrease length of stay. Requirements:Formal workin...
Tenet Healthcare Corporation Lakewood, CA
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...
NSHS Parent and Shared Service Manhasset, 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...
Step 7 Clinton, MD
Utilization Review Nurse/Case Manager Our Client is seeking a qualified candidate with experience in Utilization Review and Case Manager. Our Client Our Client is an acute care hospital which serves more than 3,400 patients through its medical-surgical unit and sees nearly 45,000 patients through its emergency room each year. Requirements Qualified candidate must have current MD Nursing Lice...

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Nurse Manager

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Bachelor's
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