Utilization Review Nurse Jobs - Page 3

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147 Utilization Review Nurse jobs found on Monster.

Jobs 41 to 60 of 147
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 ...
This is a full time position based out of the Hazelwood, MO offices. At least 3-5 years of nursing experience in clinical environment is required. POSITION SUMMARY Responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency in accordance with clients-specific contract rules and guidelines and with the company's pol...
Glendale Adventist Medical Center Glendale, CA, 91206
The Utilization Review Nurse works as part of a multidisciplinary team across the continuum of care to initiate, implement, and coordinate all aspects of utilization management and discharge planning from pre-admission through post-discharge for an assigned patient population. Primary focus is to work with physicians to assure documentation of medical necessity is complete for all payers and to as...
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 ...
Utilization Management for the assigned inpatient 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 pe...
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 sense of secu...
Johns Hopkins Hospital/Health System Glen Burnie, MD, 21060
Johns Hopkins employs more than 20,000 people annually across our health system. When joining Johns Hopkins, you became part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate loca...
Alegent Creighton Health Lexington, KY
Utilization Review Nurse - SJH - - Casual - 1400026630 Description 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. Cooperates with outside...
Job Description How To Apply We encourage you to complete all questions on the candidate profile if you wish to be considered for this opportunity. Org Marketing Statement 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...
Catholic Health Initiatives Lexington, KY
Utilization Review Nurse - SJH - - Casual - 1400026630 Description 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. Cooperates with outside...
Marten Transport Charlotte, NC
Utilization Review Nurse RN Apply Now Job Description Location: Huntersville, NC Job Summary: The employee's number one job responsibility is to deliver the most remarkable patient experience, in every dimension, every time, and understand how he or she contributes to the health systems vision of achieving that commitment to patients and families. The Utilization Review RN serves as a leader resou...
AIDS Healthcare Foundation Fort Lauderdale, FL
Responsibilities: Summary: Utilization Review is the process in which medical review determinations are made based on clinical guidelines and structured processes. This position reviews the utilization of the organization/plan's resources against established criteria, monitors and evaluates the medical necessity, appropriateness and efficient use of health care services. The position also provid...
BMC HealthNet Plan Springfield, MA
Job Description Functions as the liaison for hospital staff, PCP, other healthcare team members and BMCHP staff telephonically. Educates network providers on Plan benefits and network services. Responsible for maintaining current knowledge of the developments in medical technology, and legislation pertinent to managed care settings, patient rights, safety regulations and BMCHP contractual and org...
BMC HealthNet Plan Boston, MA
Job Description Functions as the liaison for hospital staff, PCP, other healthcare team members and BMCHP staff telephonically. Educates network providers on Plan benefits and network services. Responsible for maintaining current knowledge of the developments in medical technology, and legislation pertinent to managed care settings, patient rights, safety regulations and BMCHP contractual and org...
All's Well Health Care Long Beach, CA
Job Description Case Management Nurse Position Summary: The Case Management Nurse, will be responsible for providing guidance and leadership in the daily concurrent review of all admissions. He/she will screen cases for possible case management services according to predetermined, communicated, criteria. Authorize inpatient and/or outpatient treatment according to company's stated criteria. Cons...
Kelly Services Louisville, KY
Description RN - Utilization Review Nurse in Louisville, KY Kelly Healthcare Resources Work with the best in the industry. Every day, Kelly Healthcare Resources (KHR) specializes in providing highly skilled nursing and allied health professionals within hospitals and other health care facilities, as well as positions in sectors such as insurance, pharmaceutical, health management and education...
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 ...
Henry Ford Hospital Dearborn, MI, 48120
Overview Our health system thrives on teamwork, and we know our employees achieve the greatest results when they are working together for a common goal - to provide care for our patients. If you enjoy working in a collaborative environment then we have a job for you! Henry Ford Health System is one of the country's largest health care systems and a national leader in clinical care, research and ...
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...
Tenet Healthcare Corporation Lakewood, CA, 90711
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. CA RN or LVN license Minimum of 3 years case management, utilization...

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Nurse Manager

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