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Utilization Review Nurse Jobs

258 jobs

Job Description: We're looking for experienced clinicians to join the fast-growing Utilization Management team in our Los Angeles office. We're working to bring a new level of service to utilization review and ensure company members receive access to appropriate care in a timely, transparent way. As a Utilization Review Nurse, you will determine the medical appropriateness of inpatient and outpat...
Job Description: Utilization Review Nurse Utilization Review Nurse Job Summary: A reputable and growing client of ours is seeking a Utilization Review Nurse, near the Culver City area. As the Utilization Review Nurse you will be working alongside the utilization management team to improve medical appropriateness of in/out patient services by reviewing clinical information and applying evidence ...
Excellent full-time career opportunity for an experienced Nurse.The Utilization Review Nurse coordinates UR and case management activities for commercial and Medicare enrollees. Reviews referral/service requests on assigned patients in accordance with NCQA timeliness standards and health plan benefit structure. Prepares and presents cases for medical director review. Identifies and refers patie...
Utilization Review Nurse (RN) - Managed Care Salinas, CA Your Job Summary: The Utilization Review Nurse is responsible for utilization management and utilization review for prospective, concurrent, or retrospective review. The UR Nurse will performs reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical g...
Number of Openings: 1 Requisition Number: 16-11720 Job Title: Utilization Review Nurse Department: 16355-Utilization Review City: Seattle State: Washington Location: Roosevelt Commons Secondary Location: Union: None Work Status: Regular Shift: Day Shift FTE/Hours per pay period: 1.0 FTE (80 hours per bi-weekly pay periods) Hours Per Shift: Call Hours: Work Days: Monday-Fr...
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 necessary to appropriate physicians/vendors in a timely manner. Responsibilities: Review authorization requests for medical appropr...
Under supervision, to provide and implement a hospital utilization review and discharge planning program; and to do related work as required. DISTINGUISHING CHARACTERISTICS: Positions in this classification are assigned to the Utilization Review division of Kern Medical. Incumbents perform clinically oriented medical chart reviews and other administrative tasks to meet the requirements of the me...
In the performance of their respective tasks and duties all employees are expected to adhere to all IASIS and Health Choice policies and procedures, URAC or NCQA standards, department specific rules, annual educational requirements, IASIS Standards of Conduct, federal and state contract requirements, and all other federal and state laws. Read, abide by, and demonstrate an understanding of all pol...
Job Description: Immediate need for experienced clinicians to join a fast-growing Utilization Management team in Los Angeles! As a Utilization Review Nurse, you have the opportunity to determine the medical appropriateness of inpatient and outpatient services by reviewing clinical information and applying evidence-based guidelines. Working out of the Culver City office, you get to collect releva...
Growing MLTC Organization Job Description Audit and analyze patient records to ensure quality patient care and appropriateness of services. Review all inpatient admissions and initiate discharge planning in a timely manner Perform retrospective medical record review for inpatient or outpatient services Utilize clinical skills, chart review, physician communication, and clinical criteria for a...
CARING ONE LLC Utilization Review Nurse Caring One is a leading provider of healthcare information services for hospitals, MCOs, TPAs, and other healthcare provides, enabling them to manage cases, supervise treatment plans, obtain patient information, and improve patient outcomes. Our mission is to help healthcare organizations accomplish their patient and client service objectives through globa...
One of our best clients is currently seeking a Utilization Review Nurse in Rochester, NY! Qualifications & Requirements: Utilization Management experience Valid and Active RN license in the state of NY Strong PC skills Medicare and Medicaid guidelines experience Knowledge of InterQual criteria is preferred but not required as this is trainable If you or anyone you know is interested, send y...
The Judge Group is currently seeking a Utilization Review Nurse (RN or LPN) in Ontario, CA! This job will have the following responsibilities: Collect member information to review and certify medical necessity of prospective, concurrent and retrospective units of inpatient and outpatient services. Review cases ti determine the most appropriate setting for services, the mo st cost efficient meth...
Utilization Review Nurse (RN) - Managed Care Rochester, NY Your Job Summary: The Utilization Review Nurse is responsible for utilization management and utilization review for prospective, concurrent, or retrospective review. The UR Nurse will performs reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical...
Description POSITION SUMMARY: The Case Manager is responsible for assessing discharge-planning needs for the patients of all ages to coordinate the delivery of services to meet those needs; to facilitate timely and appropriate discharges from the hospital and to identify opportunities fro improvements in patient care. In addition the case manager must provide documentation of all functions as re...
Job Description: Seeking registered nurse or LPN/LVN for medical consulting company with utilization review and precertification experience. Prefer workers’ compensation background with knowledge of national guidelines such as CA MTUS/ACOEM and ODG. Preference in either Mountain or Pacific Time zones due to hours required for customers. The applicant must have computer, high speed internet and ac...
Job Description: Are you looking to make a difference in your community while advancing your career? Come work with a local non-profit health care plan offering coverage and a provider network to San Mateo County’s underserved population! The Utilization Management Registered Nurse will proactively work to improve member outcomes while coordinating an interdisciplinary approach to their care. Uti...
GENERAL SUMMARY Under the direction of The Director of UM/Appeals assists in the administration of utilization functions, the Utilization Review Nurse, assesses patient insurance/status to facilitate appropriate completion of utilization review using payer specific criteria; uses Interqual and MCG to determine medical necessity and appropriateness of inpatient or observation status ; serves as co...
GENERAL SUMMARY Under the direction of The Director of UM/Appeals assists in the administration of utilization functions, the Utilization Review Nurse, assesses patient insurance/status to facilitate appropriate completion of utilization review using payer specific criteria; uses Interqual and MCG to determine medical necessity and appropriateness of inpatient or observation status ; serves as co...
EXCITING JOB OPPORTUNITY with a rapidly growing organization. This role is an amazing opportunity to grow and diversify your career as a NURSE. This role is an administrative nursing position, in which you will engage in medical record review, in order to build quality reports based on given criteria. ABOUT THE COMPANY: Nexus is dedicated to connecting quality physicians with the outcome needs o...