Skip to main content
X

Get jobs by email for this search

By continuing you agree to Monster's Privacy policy, Terms of use and use of cookies.

Utilization Review Nurse Jobs

236 jobs

In the performance of their respective tasks and duties all employees are expected to adhere to all IASIS and Health Choice policies and procedures, URAC or NCQA standards, department specific rules, annual educational requirements, IASIS Standards of Conduct, federal and state contract requirements, and all other federal and state laws. Read, abide by, and demonstrate an understanding of all pol...
Case Management & Utilization Review Nurse (RN) – Hospital Phoenix, AZ (Downtown Scottsdale) *** Full Time, with Substantial Benefits, with the expectation that it will convert to a Remote (Tele-commute / Work From Home) position after initial training period. *** ** Some Flexibility on work hours to aid in Commute or Scheduling issues! ** * 23 days PTO your first year! * Your Job Summary: ...
Judge Healthcare is currently seeking a Utilization Review Nurse in Troy, MI! Responsibilities: Perform Utilization Review for Medicaid & Medicare cases, phone calls and data entry Qualifications & Requirements: Current, active RN license in Michigan At least 1 year of UR/UM experience At least 1 year of Interqual experience Computer skills - Microsoft Office & Excel For immediate consider...
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 ...
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 ...
We have been retained by one of New York States largest managed care insurers seeking a Utilization Review Nurse Supervisor. This is a direct hire opportunity in the Capital Region with a generous salary and benefit package. Ideal candidates will possess the following: RN license (NYS). BSN preferred. 3-5 years supervisory experience. Expertise in utilization management & review, compliance, a...
JOB DESCRIPTION TITLE: UTILIZATION REVIEW NURSE CLASSIFICATION: EXEMPT REPORTS TO: UTILIZATION REVIEW NURSE JOB OVERVIEW: The Utilization Review Nurse is responsible for the analysis and management of medical issues and treatment in workers’ compensation claims. This position will review to authorize, partially authorize or delay treatment in accordance with the Medical Treatment Utilization ...
Job Summary * The Utilization Review Nurse I provides first level clinical review for all outpatient and ancillary services requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a professional and competent man...
[[id]] Job Summary * The Utilization Review Nurse I provides first level clinical review for all outpatient and ancillary services requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a professional and compe...
Overview: Performance Management Responsibilities: Performance Management Qualifications: Formal Education:Associate Degree or certification equivalent Experience:5 years License, Registration, and / or Certification Requirement:Yes Minimum Knowledge:Requires advanced knowledge of a specialized or technical field or a thorough knowledge of the practices and techniques of a professional fie...
Job Description: Utilization Review Nurse We are seeking a Utilization Review Nurse for our Facility. Summary: Perform technical and administrative work required to evaluate the necessity, appropriateness based on medical criteria, and for referrals to Medical Directors, for any requests that do not meet medical necessity criteria. Also responsible for the management of health care resources nece...
Job Description: Axion Healthcare is looking to conduct interviews immediately for this contract position in Brooklyn. If you are a qualified candidate meeting the minimum requirements below then please apply with your resume and cover letter accordingly. Job Opening: Care Coordinators NEEDED!!! (RN) Position: Contract Assignment, Temp-Hire with a large MLTC. Monday thru Friday 9 AM- 5 PM In offi...
Short Description: Responsible for Performs utilization review in accordance with all state mandated regulations. Maintains compliancy with regulation changes affecting utilization management. Reviews patients’ records and evaluates patient progress. Performs continuing review on medical records and identification and need of on-going hospitalization. Obtains and reviews necessary medical report...
The RN provides clinical review and decision-making following specific clinical coverage position criteria and established clinical guidelines for targeted health claims and customer and healthcare professional appeals. The nurse decision-making is based on Cigna's accepted clinical criteria sets, regulatory requirements, contractual benefits and specific customer medical circumstances. Coverage r...
Overview: As a patient-focused organization, the University of Utah Health Care exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health Care seeks staff that are committed to the values of compassion, collaboration, innovation, res...