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Utilization Review Nurse Jobs

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QUALIFICATIONS: Education: Graduate of an accredited nursing program; Bachelor's degree in Nursing, preferred. Licensure: Licensed as a registered nurse, or eligible for licensure in Commonwealth of VA. Experience: Minimum three years of professional practice experience in an acute care setting. Prior Utilization Management preferred. CPHM desirable. Working knowledge of diagnosis, expected tr...

JOB DESCRIPTION: Validates the appropriateness of hospital admissions according to nationally recognized standards. Reviews inpatient and observation cases for compliance with the Utilization Review Plan filed with the State of Georgia. Takes the appropriate action to comply with third party payor requirements. Performs related responsibilities as required. MINIMUM QUALIFICATIONS: Graduate of an ...

Job TitleRN Utilization Management Analyst, EUH, Utilization Review, 8am-4:30pmJob Requisition ID50927BREmployerEmory HealthcareOperating Unit/DivisionEmory University HospitalDepartment350270:EUH Utilization ReviewFull/Part TimeFull-TimeRegular/TemporaryRegularPRN Position? (For University, leave set to All)NoJob DescriptionJOB DESCRIPTION: Validates the appropriateness of hospital admissions acc...

The Utilization Review Specialist functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. Certifications and Licensures Required LPN (Licensed Practical Nurse) Education Required...

The Utilization Review Specialist functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. Certifications and Licensures Required LPN (Licensed Practical Nurse) Education Required...

Description: Collaborates with all members of the health care delivery team to enhance the provision of patient care services and safety from admission to discharge. Functions as the lead member of the care coordination team to ensure high quality patient care, appropriate length of stay, excellent resource utilization, and ensure reimbursement for services rendered. Facilitates the safe movement ...

Collaborates with all members of the health care delivery team to enhance the provision of patient care services and safety from admission to discharge. Functions as the lead member of the care coordination team to ensure high quality patient care, appropriate length of stay, excellent resource utilization, and ensure reimbursement for services rendered. Facilitates the safe movement of the patien...

Collaborates with all members of the health care delivery team to enhance the provision of patient care services and safety from admission to discharge. Functions as the lead member of the care coordination team to ensure high quality patient care, appropriate length of stay, excellent resource utilization, and ensure reimbursement for services rendered. Facilitates the safe movement of the patien...

The Position Supplemental Questions Final Filing Date: Open Until Filled The Contra Costa County Health Services Department is recruiting to fill one (1) vacant Utilization Review Manager position in the Utilization Management/Authorization unit of the Contra Costa Health Plan, located in Martinez, California. The Utilization Review Manager plans, organizes and supervises the activities of the...

Collaborates with all members of the health care delivery team to enhance the provision of patient care services and safety from admission to discharge. Functions as the lead member of the care coordination team to ensure high quality patient care, appropriate length of stay, excellent resource utilization, and ensure reimbursement for services rendered. Facilitates the safe movement of the patien...

[[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 compete...

Nurse Reviewer - LPN 5MONTH CONTRACT TO HIRE 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 Nurse Reviewer with our large medical insurance client. This is a full time day shift position. No weekends No holidays! SUMMARY: Responsible for ...

Nurse Reviewer - LPN 5+ MONTH CONTRACT TO HIRE 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 Nurse Reviewer with our large medical insurance client. This is a full time day shift position. No weekends No holidays! SUMMARY: Responsible fo...

Utilization Review Nurse - LPN Department: Case Management Schedule: Full Time Shift: Days Hours: M-F; varies Job Details: 1, Previous Experience Required a. Three to five years of clinical nursing experience of which at least two years were in direct patient care areas preferred. b. Utilization Review experience preferred. 2. Specialized or Technical Education Requirements a. Licensed Pract...

1, Previous Experience Required a. Three to five years of clinical nursing experience of which at least two years were in direct patient care areas preferred. b. Utilization Review experience preferred. 2. Specialized or Technical Education Requirements a. Licensed Practical Nurse currently licensed to practice in the State of Louisiana. b. Knowledge of Prospective Payment System, DRG’s, and Peer...

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Work Location: United States-Nevada-Las Vegas-Sunrise Hospital and Medical Center Schedule: Part-time The RN Case Manager/Utilization Review Nurse is responsible for assessing descharge-planning needs for the patients to coordinate the delivery of healthcare services in conjunction with nursing, physicians, ancillary hospital departments, patients and families, and to identifiy and corrdinate po...

Job Summary Oversees the integrated Care Access and Monitoring team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Monitors information daily as appropriate including member metrics and staff product...

Job Summary Oversees the integrated Care Access and Monitoring team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Monitors information daily as appropriate including member metrics and staff product...