Utilization Review Nurse Jobs

1000+ jobs

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 ...

Title: Utilization Review Nurse Duration: 3+ Months Contract Work Location: Indianapolis, IN, 46241 Position Qualifications/Requirements: Education and Training: Associates RN degree required, Bachelor’s degree preferred. Experience: Two years of experience in managed care quality assurance or utilization review. RN must have two years of experience in an acute care hospital. Position Summ...

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...

Summary The RN Care Manager/UMRN is responsible for projecting and integrating the Mission and Core Values of the organization in the provision care management services to members of the AHF/AHFMCO Medicare and Medicaid health plans of Florida. Key responsibilities include leading the care needs of members which provides culturally and linguistically sensitive care management services to the HIV...

Position Description: We are currently seeking a Nurse Reviewer/Telephonic Case Manager with a compact state RN license. 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...

Facilitates a process of assessment, planning and advocacy for options and services to meet an individuals health needs through communication and available resources to promote quality cost effective care. Validates appropriate level of care (severity of illness), efficient and effective care delivery (intensity of services) and safe discharge to the next appropriate level of care. Conducts admiss...

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...

Judge Healthcare is currently seeking a Utilization Review RN with one of our outstanding clients in the Indianapolis, IN area! This job will have the following responsibilities: Responsible for conducting timely reviews of all requests for services required to meet medical necessity criteria to include reviewing pre-certification for outpatient and inpatient services. Applying criteria to inpat...

RN/Case Manager Kelly Services has an exciting opportunity for an RN / Case Manager to come work with our client located in Franklin, TN. This is an exciting opportunity to work for a large property/casualty third party administrator assisting them with keeping the wheels of the health care industry turning. Apply today! DESCRIPTION: A Registered Nurse to provide utilization management review o...

Position Description: Total Care, a subsidiary of Universal American is a New York Stock Exchange company with annual revenues of more than $2 billion. Through our family of healthcare companies, we provide health benefits to people covered by Medicare and/or Medicaid. We are dedicated to working collaboratively with healthcare professionals in order to improve the health and well-being of those ...

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 Syracuse, NY. 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, and c...

Judge Healthcare is actively seeking a qualified Utilization Review Registered Nurse for an opening with one of our best clients in the Syracuse NY area! Summary: Performs utilization review in accordance with all state and federal mandated regulations. Reviews member records and, using approved criteria and member benefit information, ensures appropriate and cost-effective healthcare services ...

Utilization Review Nurseneeded for apermanentopportunity with Yoh's client located inSanta Clara, CA. The Big Picture - 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 - P...

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, ...

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...

Position Description: We are currently seeking a Utilization Review Nurse/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...

Utilization Review Nurseneeded for acontract to hireopportunity with Yoh's client located inSanta 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 ...

TML MultiState IEBP is a non-profit organization in Austin. We are dedicated to offering competitive health benefits to eligible entities. We were voted one of the top workplaces in Austin for 2014. Responsibilities of the Utilization Review Nurse include, but are not limited to: Performs telephonic precertifications Concurrent review Retro/claims reviews Discharge planning Quality customer ...

Utilization Review Nurse Position Available in the Minnetonka, MN area Kelly Services is currently seeking a Temporary Utilization Review Nurse for one of our top Health Insurance clients in Minnetonka, MN This position will be responsible for Coordinating Review Functions in the Utilization Management and Clinical Appeals Department Additional responsibilities include: Complete and accurate p...

Nursing your career: isn't it time to join Parallon? Get the career growth opportunities and independence you deserve with Parallon. As one of the nation's first and largest providers of healthcare services we work with you to reach your goals both personally and professionally. We are committed to the care and improvement of human lives and strive daily to deliver top talent so as to uphold that...