Utilization Review Nurse Jobs

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Description: There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse you wi...

Performs telephonic utilization review services in compliance with Federal and state regulations, and the URAC standards for client members seeking healthcare treatment and services. High analytical ability to define and describe complex problems. Obtain and document all medical information and complete a timely review of health care services covered under Sage Technologies Clinical Services depa...

Our client is currently seeking a Utilization Review RN. This job will have the following responsibilities: Responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans The UM Nurse determines medical appropriateness of inpatient and outpatient services Performs utilization review activities, including pre-certification, concurrent, and retrospective ...

Kelly Services has an exciting opportunity available for a Contract Clinical Utilization Review Nurse to come work with our client located in Minnetonka, MN. As the Clinical Utilization Review Nurse, you’ll work behind the scenes to maximize cost efficiency and quality of various health care services. Through reviews and audits, you’ll ensure that patients receive care they need without burdening ...

Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected health care management companies, operating through its subsidiaries acute care hospitals, behavioral health facilities and ambulatory centers nationwide. Founded in 1978, UHS subsidiaries now have more than 65,000 employees. The UHS business strategy is to build or purchase health care properties in rapidly gr...

Requisition Number17452 Reg/TempRegular Employment TypeFull-Time ShiftRegular Work Schedule8-5 M-F CitySALT LAKE CITY StateUtah DepartmentUUH CST 33A REHAB SVCS ADMIN.- 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...

Utilization Review Nurseneeded for adirect hireopportunity with Yoh's client located in South San Francisco, CA. Top Skills You Should Possess: - Experience in a managed car setting - Knowledge of Medicare & Medi-Cal What You'll Be Doing: - Ensure medically appropriate, high quality, cost effective care by assessing the medical necessity of outpatient services, elective admissions, diagnostic...

Perform Utilization Review of workers' compensation claims, based on review criteria and protocols in accordance with state and regulatory agency compliance. Conduct prospective, concurrent and retrospective reviews to determine medical necessity and appropriateness of requested services. Compare treatment episodes to clinical criteria for certification or referral to medical director. Document ut...

Utilization Review RN I have a permanent job Utilization Review RN - 1505035812 Arizona - Phoenix 85021If Interested pl send me your resume asap with Contact number, Immigration status, Expected Salary. Thanks Debdas Patnaik 248 795 0378 ***** Our company is a leading healthcare business process management services provider working to improve operational performance for more t...

Description : As a part of the Tenet and Catholic Health Initiatives family, Conifer Health Solutions is a leading healthcare business process management services provider working to improve operational performance for more than 600 clients so they can support financial improvement, enhance the patient experience, and drive value-based performance. Through our revenue cycle management, patient c...

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 Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Utilization Review Nurse to perform utilization reviews ensuring that HPSM members receive necessary medical care in a timely and cost-effective manner. This position will report to the Health Services Utilization Review Manager. Primary duties: Ensures medically appropriate, high quality, cost effective care by a...

Specializing in Behavioral Health, this position performs telephonic utilization review services in compliance with federal and state regulations, and the URAC standards for client members seeking healthcare treatment and services. High analytical ability to define and describe complex problems. Obtain and document all medical information and complete a timely review of health care services cover...

Utilization Review RN - Managed Care Albany, NY Your Job Summary: The Utilization Review Nurse is responsible for utilization management and utilization review for prospective, concurrent, or retrospective review. The UR Nurse will performs reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines...

Utilization Review RN - Managed Care Buffalo, NY Your Job Summary: The Utilization Review Nurse is responsible for utilization management and utilization review for prospective, concurrent, or retrospective review. The UR Nurse will performs reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guideline...

Utilization Review RN - Managed Care San Francisco, CA Your Job Summary: The Utilization Review Nurse is responsible for utilization management and utilization review for prospective, concurrent, or retrospective review. The UR Nurse will performs reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical gui...

Case Management & Utilization Review Nurse (RN) – Managed Care New York, NY (Downtown Manhattan) *** This is a full-time, benefits available, CONTRACT position, expected to last 3-4 months, or longer! *** Your Job Summary: As a member of the medical management team, the Case Management & Utilization Review Nurse plays an integral part in the coordination of care assessing the member’s conditio...

Judge Healthcare is actively seeking a full time Utilization Review RN for an outstanding healthcare client of ours in the state of Oklahoma!!! This position is located in Oklahoma City, OK!!! The right candidate must possess the following qualifications: Valid Oklahoma RN Licensure Prior utilization review experience Please send your MOST UP TO DATE resumes to Suzanne at *****...

Judge Healthcare is currently seeking a Utilization Review RN for a health plan located within the Baltimore area! This job will have the following responsibilities: This position oversees utilization management activities on behalf of the members by assessing the necessity and efficiency of services through systematic monitoring of medical necessity and quality in accordance with established cr...

Responsible for management of day-to-day operations of the Utilization Review department including evaluation of daily data capture, quality assurance, program implementation, training and management of staff to achieve performance improvement, revenue enhancement and meet the managed care objectives of the company. Manage the daily operational activities of the unit from UR referral receipt to cl...