Utilization Review Nurse Jobs - Page 3

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162 Utilization Review Nurse jobs found on Monster.

Jobs 41 to 60 of 162
BMC HealthNet Plan Springfield, MA, 01105
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 organizational speci...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Faith Regional Health Services Norfolk, NE, 68701
Respond to telephone and face-to-face inquiries seeking mental health care or information. Communicate all pertinent information about patients to psychiatrist or mid-level provider supervising patient admission. Coordinate patient admission from the Emergency department to the in-patients unit including all necessary communication to nursing unit staff. Document inquiry calls and related informat...
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...
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...
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, 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...
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...
IASIS Healthcare Phoenix, AZ, 85002
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 physician, the m...

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Nurse Manager

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