Utilization Review Nurse Jobs

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1000+ Utilization Review Nurse jobs found on Monster.

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Registered Nurse – Utilization Review – Case Management – Utilization Review - RN Registered Nurse – Utilization Review – Case Management – Utilization Review - RN Just outside Seattle, WA Great Salary Range Full Benefits Package Registered Nurse – Utilization Review – Case Management – Utilization Review - RN This facility is looking for a utilization review registered nurse. Our case manag...
Bethany Methodist Hospital of Chicago—located in Andersonville on the north side of Chicago—is a 168-bed, nonprofit, non-sectarian hospital hosting a full complement of highly qualified physicians and other healthcare professionals. The Hospital offers a very distinctive caring approach to healthcare for today's senior population, as well as others. Methodist Hospital is fully equipped with the mo...
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 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 ...
Utilization Review Nurse Full-time, M-F, 8:30 am - 5:00 pm The Utilization Review Nurse is responsible for the development, implementation, coordination, and follow-up of projects related to Mercy Care Management. This includes the validation, assimilation, and integration of information derived from projects, focus studies, in network and out of network pre-certification, inpatient concurrent r...
RN/Medical Reviewer Kelly Services has an exciting opportunity available for a RN/Medical Reviewer to join our client located in Wilkes-Barre, PA! As the Medical Reviewer, you’ll be reviewing and auditing medical records for completeness and accuracy by looking at various pieces of documentation. If records are missing important information it will be your duty to ensure that the information is i...
The primary function of a Nexus Utilization Review Nurse is to review and analyze medical records for medico-legal reviews. After analyzing provided clinical documentation, Utilization Review Nurses must create a professional executive report that includes a summary, appropriate criteria/guidelines, and a rationale based on evidence based guidelines. The executive summary will review the patient’s...
TRISTAR Managed Care is in need of a medical case manager who will mainly handle utitization review for our Texas offices.The medical case manager coordinates resources and cost effective options on a case-by case basis to facilitate quality individualized treatment goals and return to work placement. This is a full-time work-from-home position with bonus, full benefits and other perks. ESSENTIAL...
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...
What Is Done On This Job: Perform prospective and retrospective medical review and preauthorization of selected procedures utilizing InterQual criteria. Record and report managed care activities including overutilization or quality of care issues. Perform concurrent review of selected services. Interpret complex medical and surgical care. Assist in development and ongoing revision of managed ...
Judge Healthcare is actively seeking a full time Utilization Review Registered Nurse for an outstanding healthcare client of ours in the state of Oklahoma!!! This position is located in Oklahoma, OK!!! The right candidate must possess the following qualifications: Active RN license in the state of Oklahoma. Associates Degree in Nursing Prior utilization review experience desirable Call center...
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 ...
Utilization Review Nurse - RN Kelly Services has an exciting opportunity available for a Utilization Review Nurse - RN to come work with our client located in Oklahoma City, OK. As the Utilization Review Nurse- RN, you'll work behind the scenes to maximize cost efficiency and quality of various health care services. Within the scope of practice, responds to calls, conducts certification reviews, ...
JOB SUMMARY: REGISTERED NURSE (RN) UTILIZATION REVIEW / HMO Review request for medical appropriateness and/or medical necessity Approve, deny or appeal medical coverage for inpatient and outpatient services Assess the patient's needs after a hospitalization Confirm that the plan provides coverage for a particular medical service, minimize costs and determine if the recommended treatment is app...
RN's and LPN's needed for Utilization Review positions within a national managed care organization. Want to expand your knowledge in an area of nursing that not a lot of people know about? Want to do something completely different from what you've been doing? Utilization Review nurses work with hospital and MCO case managers, and care coordinators to create a care plan and expedite services and c...
Judge Healthcare is actively seeking a Nurse withUtilization Management Experience within Prior Auth and Concurrent Review, fora position in the Long Beach CA area. California Children Services- experience preferred! UM experience- at least 2 years Prior Auth experience Concurrent Review experience Determining if a patient has ccs eligiblecondition, and creating application is eligible Summa...
Registered Nurse (RN)/ (LPN) Review Analyst Responsible for the approval or rejection of claims Admissions approvals Telephone triage Benefit interpretation May be required to enter or reference data via PC and/or CRT terminal. Other related skills may be required to perform this job. Expertise in the use of medical terminology Utilization Review Details 40 hours/week -overtime as needed...
At Gallagher Bassett Services, Inc. (GB) we are constantly seeking skilled professionals who are up for a challenge and take exceptional performance to heart. The professionals we hire help us maintain our reputation as one of the most progressive property/casualty third party claims service organizations in our industry and throughout the world. Gallagher Bassett provides services to Fortune 1000...
Utilization Review Nurseneeded for acontract to hireopportunity with Yoh's client located in Santa 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...
Utilization Review Nurse 4+ MONTH TO HIRE CONTRACT EMPLOYMENT LOCATION: El Dorado Hills, CA Every day, Kelly Services connects professionals with opportunities to advance their careers. We are currently recruiting for an exciting contract opportunity as a Utilization Review Nurse with our large medical insurance client. This is a full time day shift position. No weekends No holidays! SUMMARY: ...

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