Utilization Review Nurse Jobs

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162 Utilization Review Nurse jobs found on Monster.

Jobs 1 to 20 of 162
Futures of Palm Beach is a one-of-a-kind residential eating disorders and substance abuse program with un-paralleled clinical programming. We offer evidenced based treatment, with a strong psychotherapeutic approach, with an additional focus developing leading edge treatments in both eating disorders and addictions. Futures is part of a growing company, with additional programs planned for U.S. an...
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 of collaboration, excellence, leadership, and respect. University of Utah Health Care seeks staff that are committed to the values of compassion, collaboration, innovation, res...
Judge Healthcare is currently seeking a Utilization Review Nurse in Syracuse, NY 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 to members. Assists Care Coordination staff in the identification, assessment, manag...
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...
Mountain View Regional Hospital, the premiere surgical specialty hospital in Casper, Wyoming, and the Rocky Mountaint region, is looking for motivated, enthusiastic applicants wishing to be a part of our exceptional team. We are seraching for: Utilization Review RN / Dishcarge Planner (FT): Manages patients in the healthcare contiuum to achieve optimal clinical, financial, operational and patien...
Company: Yoh Utilization Review Nurse needed for a permanent opportunity with Yoh's client located in Santa Clara, CA. The Big Picture - Top Skills You Should 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 clin...
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...
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 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...
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.​ Workers Compensation Utilization Review Nurse SUMMARY: Responsible for performing workers compensation utilization review for multiple s...
Health Services for Children with Special Needs, Inc. in Washington, DC is currently seeking self-motivated candidates for a Utilization Review (UR) Nurse to focus on our inpatient members. The Utilization Review (UR) Nurse is responsible for the clinical review of pediatric and young adult members for all inpatient stays, homecare, outpatient rehabilitative therapy, durable medical equipment and ...
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...
Alegent Creighton Health Lexington, KY
Utilization Review Nurse - SJH - FT - Days - 1400022844 Description Job Summary: Responsible for Utilization Review for medical necessity and level of care for patients accessing services at St. Joseph Hospital and St. Joseph East, though the application of InterQual Criteria and other resources as necessary. Determines correct patient status and obtains order from admitting physician. Cooperat...
eQHealth Solutions Lombard, IL
Job Description We are a Quality Improvement Organization serving Illinois’ Medicaid population and are seeking a full time or part time Utilization Review Nurse. The successful candidate will render accurate first level utilization and quality review determinations based upon application of approved medical necessity criteria and quality screens. Job Requirements This candidate must have an ac...
First Health of the Carolinas Pinehurst, NC, 28370
Bachelor’s Degree in Nursing with a minimum of 3 years nursing experience in medical/surgical, critical care and/or hospice, home health or public health required or Associate Degree in Nursing with a minimum of 4 years experience in medical/surgical, critical care and/or hospice, home health or public health required. Masters Degree in Nursing or related field preferred. Case Management/CPHM cert...
NSHS Parent and Shared Service Manhasset, NY
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...
Mercy Healthcare Springfield, MO, 65802
The Utilization Review Nurse is responsible for the development, implementation, coordination, and follow-up of projects related to Mercy Care Management. This includes the validation, assimilation, and integration of information derived from projects, focus studies, in network and out of network pre-certification, inpatient concurrent review and retrospective chart review. Performs related duties...
Healthcare Employment Partners Clinton, MD
Utilization Review Nurse/Case Manager Our Client is seeking a qualified candidate with experience in Utilization Review and Case Manager. Our Client Our Client is an acute care hospital which serves more than 3,400 patients through its medical-surgical unit and sees nearly 45,000 patients through its emergency room each year. Requirements Qualified candidate must have current MD Nursing Lice...
Tenet Healthcare Corporation Lakewood, CA
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...
Description People want to be treated like individuals. At Cigna, we get that. That’s why we embrace and encourage peoples’ uniqueness, helping to give them the strength and confidence to show the world who they really are. The coverage, expertise and services we provide are at the very core of how we help people achieve their full potential – and ultimately, improve their health, well-being and ...

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