Utilization Review Nurse Jobs

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151 Utilization Review Nurse jobs found on Monster.

Jobs 1 to 20 of 151
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...
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 ...
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...
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...
Mountain View Regional Hospital, the premiere surgical specialty hospital in Casper, Wyoming, and the Rocky Mountaint region, is looking for motivated, enthusiastic applicants wishing to be a part of our exceptional team. We are seraching for: Utilization Review RN / Dishcarge Planner (FT): Manages patients in the healthcare contiuum to achieve optimal clinical, financial, operational and patien...
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...
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...
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 ...
Description People want to be treated like individuals. At Cigna, we get that. That’s why we embrace and encourage peoples’ uniqueness, helping to give them the strength and confidence to show the world who they really are. The coverage, expertise and services we provide are at the very core of how we help people achieve their full potential – and ultimately, improve their health, well-being and ...
Henry Ford Health Dearborn, MI
Overview Our health system thrives on teamwork, and we know our employees achieve the greatest results when they are working together for a common goal - to provide care for our patients. If you enjoy working in a collaborative environment then we have a job for you! Henry Ford Health System is one of the country's largest health care systems and a national leader in clinical care, research and ...
St. Joseph Medical Center Phoenix, AZ
Description The Utilization Review Nurse completes inpatient admission and concurrent reviews for Health Choice members, considering Interqual criteria and other national standards, policy and procedures and the members's medical benefits. Reviews are made on-site, telephonically, and via fax. Assist and coordinates the discharge planning needs of the member with the facility staff, attending phy...
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...
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...
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...
Alegent Creighton Health Lexington, KY
Utilization Review Nurse - SJH - FT - Days - 1400022844 Description Job Summary: Responsible for Utilization Review for medical necessity and level of care for patients accessing services at St. Joseph Hospital and St. Joseph East, though the application of InterQual Criteria and other resources as necessary. Determines correct patient status and obtains order from admitting physician. Cooperat...

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