Utilization Review Nurse Jobs

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204 Utilization Review Nurse jobs found on Monster.

Jobs 1 to 20 of 204
Job Description: This RN Utilization Review Nurse Position Features: ? Growing Patient Base ? Awesome Work Environment ? Great Pay to $80K LOOKING FOR GREAT OPPORTUNITY AND NOT GETTING TIED DOWN? Managed care health plan, seeks a Utilization Review (UR) Nurse to perform utilization reviews to assure that HPSM members receive necessary medical care in a timely and cost-effective manner. The U...
MHM Services and Centurion of Tennessee are proud to be the provider of medical services to the Tennessee Department of Corrections. We are currently seeking Utilization Review/Utilization Management Nurses to oversee the medical services requests and ensure the appropriate level of care at the facilities within the Tennessee Dept of Corrections. This position is based out of our Regional Office i...
Company: Yoh Utilization Review Nurse needed for a contract opportunity with Yoh's client located in Sacramento, CA. The Big Picture - Top Skills You Should Possess: - Utilization Management Experience - Case Management Experience What You'll Be Doing: - Review and process urgent and non-urgent authorization requests (via phone, fax and electronic submission) for medical necessity (according...
Job Description: This Utilization Review Nurse Position Features: ? Great Pay to $41/hr Immediate need for Utilization Review Nurse. Flexible, ability to work in a fast paced setting and positive team oriented approach will be keys to success in this dynamic organization. Will be responsible for the review or medical records, formulating recommendations and overseeing the authorization process ...
Our client in South San Francisco is looking for a Utilization Review Nurse to join their team! Duties · Conduct on-site reviews at inpatient facilities, including acute care, and/or process authorization requests for various services including but not limited to: outpatient, rehabilitation and/or home health services. · Review authorization requests for out-of-network inpatient facilities. · ...
Company: Yoh Utilization Review Nurse needed for a contract opportunity with Yoh's client located in South San Francisco, CA. The Big Picture - Top Skills You Should Possess: - Utilization Management Experience - Knowledge of Medicare and Medi-Cal What You'll Be Doing: - Conduct on-site reviews at inpatient facilities, including acute care, and/or process authorization requests for various s...
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...
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...
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 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 comm...
Tenet Healthcare Corporation Phoenix, AZ, 85002
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 communications, a...
The responsibility of a Utilization Management Nurse Care Manager is to provide detailed clinical information to insurance companies to obtain the highest level of care and the longest length of stay for our client's patients. Some of the duties include, but are not limited to: Conduct Utilization / Concurrent reviews with insurance companies for substance abuse treatment. Perform concurrent re...
North Shore Long Island Jewish
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...
MountainView Hospital
Schedule: Full-time Description TriStar Centennial Medical Center – Nashville, TN Clinical Review Nurse – Quality/Risk Management Our 657 bed hospital is both nationally and locally recognized, including being named as one of the nation's Top 100 Hospitals in the areas of cardiology, stroke, orthopaedics and breast cancer management. As a result of the continued advances in quality care, many ...
St. Joseph Medical Center Phoenix, AZ
Description Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to ...
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...
Chicago, IL Chicago, IL
Job Description MCM, a national managed care company, is growing and currently is recruiting for telephonic utilization review nurses. The ideal candidate will have an unrestricted IL LPN or RN License, with previous experience in managed care or utilization review. Computer skills are required. We offer generous benefits in our convenient Chicago Loop office. www.medicalcost.com Job Requirement...
Description Goal 1 – Appropriate Level of Care Determinations Know, understand, and utilize appropriate criteria for level of care determination. Goal 2 – Discharge Planning Know, understand, and utilize effective discharge planning as evidenced by: Development of appropriate discharge plans Incorporation of member assessment and goals into discharge plan Collaboration with PCP and other te...
Description Determines whether services provided to plan members were actually medically necessary. Develops and maintains knowledge of provider organization review procedures. Maintains reporting system for Utilization Review. Qualifications Requires a RN with typically three years of clinical experience. Strong computer skillls Utilization experience a plus...

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Nurse Manager

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