Utilization Review Nurse Jobs

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543 Utilization Review Nurse jobs found on Monster.

Jobs 1 to 20 of 543
A-Line Staffing Solutions is seeking an experienced Utilization Review Case Manager Registered Nurse professional to work within a hospital setting in the Metro Detroit area. Job Summary: Examine patient case load to ensure patient is receiving the appropriate treatment Review medical requests such as, medical imaging studies, the use of certain medications and treatments, and recommended medical...
This is a position that focuses on utilization review including assessment of medical records for appropriateness, level of care provided. You will assess utilization of treatment, modalities, medications, services and application of treatment protocols. A team approach with other members of internal staff is important. Requirements: California Nurses license, Registered Nurse (RN) Utilization Rev...
We are currently looking to hire for a full-time, permanent position of Utilization Review Nurse located in Omaha, NE. This position is working within the Medical Management department and is responsible for reviewing various medical claims and making appropriate determinations based on company guidelines. The ideal candidate will have their current RN license as well as 5+ years of recent, hands-...
Utilization Review Nurse Great opportunity for a Utilization Review Nurse to work with an industry leader in helping coordinate quality and cost effective care. Be part of a team of healthcare professionals who are dedicated to improving the quality of healthcare. MORE INSIGHT: For almost five decades this industry leader in healthcare utilization management has built a team of over 400 profession...
Utilization Review Nurse Great opportunity for a Utilization Review Nurse to work with an industry leader in helping coordinate quality and cost effective care. Be part of a team of healthcare professionals who are dedicated to improving the quality of healthcare. MORE INSIGHT: For almost five decades this industry leader in healthcare utilization management has built a team of over 400 profession...
This opportunity is with a National Managed Care Organization located in Waltham, MA! As a Utilization Review Nurse you will be responsible for the review of requests for prior authorization of medical services such as surgeries, pain management, home health care. * Candidates must be an RN with Managed Care or Acute Care Utilization Management experience! This position is full time, fully benefit...
DIRECT HIRE OPPORTUNITY for a stellar Case Manager / Utilization Review Nurse in Sacramento, CA working with a forward thinking, top-notch organization. POSITION OVERVIEW: The Utilization Review Nurse will be fielding cases for the Medicaid and Medicare member populations for a Managed Care organization. The role will require conducting precertification and/or concurrent clinical reviews for admis...
Our client is currently seeking a UTILIZATION REVIEW NURSE (RN) INT. - SAN DIEGO, CA. This job will have the following responsibilities: Collect case specific member information, review and certify the medical necessity of prospective, concurrent, and retrospective units of inpatient and outpatient services. Review each case and determine the most appropriate services, the most appropriate setting...
A-Line Staffing has 3 openings for RN / Registered Nurse / Review Analyst / Precertification / UR or Utilization Review. Hours: Monday-Friday 8a-5p with start time flexibility once training is completed. This position is an office job where you would be reviewing charts for medical necessity. Job Requirements: Utilization Review experience is a must McKesson Interqual experience is a plus Discharg...
Korak is seeking 2 RN's for the position Nurse Reviewer-Medicare Appeals Makes reconsideration determinations on Medicare appeals. Reviews cases to determine and summarize the facts of each case and assesses issues involved in the case. Reviews file to determine whether all relevant information has been submitted. Correctly identifies the denied items within the case file the denial rationale pres...
Utilization Review Nurse needed for a contract opportunity with Yoh's client located in South San Francisco, CA. Top Skills You Should Possess: - Utilization review / utilization management - Medicare & Medi-Cal What You'll Be Doing: - Conduct onsite reviews at inpatient facilities, including acute care, and/or process authorization requests for various services including but not limited to: outpa...
Job Title: Utilization Review Nurse Job Summary A Utilization Review Nurse position is a full-time, (up to 50 hours per week) and is a salaried position. The primary function of a Utilization Review Nurse is to review and analyze medical records for med-legal reviews and provide clinical documentation. Utilization Review Nurses must create a professional executive report which includes a summary,...
POSITION OVERVIEW: The Utilization Review Nurse will be fielding cases for the Medicaid and Medicare member populations for a Managed Care organization. The role will require conducting precertification and/or concurrent clinical reviews for admissions using guidelines. MORE INSIGHT: Having been the recipient of numerous prestigious awards, this elite healthcare organization is among the top on th...
National Managed Care Company sourcing for talented and motivated Mississippi Licensed RN's for a Field Nurse Case Manager, and a Utilization Review Nurse Position in Jackson, MS. The Field Nurse Case Manager must have working knowledge of Mississippi Workers' Compensation claims, injuries and return to work procedures. Nurse Case Managers / RN's will have excellent telephonic communication and te...
What We Do: MCMC's success can be attributed to our diverse and talented work force.​ Our employees are the foundation of our business and are helping MCMC grow each year.​ Because of our tremendous growth, we are always in search of outstanding individuals.​ Utilization Review Nurse, Pre-certification Nurse SUMMARY: The precertification nurse is responsible for providing utilization review servic...
This opportunity is with a National Managed Care Organization located in Palm Beach County, FL! As a Utilization Review Nurse you will be responsible for the review of requests for prior authorization of medical services such as surgeries, pain management, home health care. * Candidates must be an RN with Managed Care or Acute Care Utilization Management experience! This position is full time, ful...
This is a position that focuses on utilization review including assessment of medical records for appropriateness, level of care provided. You will assess utilization of treatment, modalities, medications, services and application of treatment protocols. A team approach with other members of internal staff is important. Requirements: California Nurses license, Registered Nurse (RN) Utilization Rev...
Tracking Code 1299 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 a...
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 a...
Tracking Code 1160 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 a...
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