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Utilization Review Nurse Jobs

306 jobs

The U.R. Nurse gathers demographic and clinical information on prospective, concurrent, and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity and assigns an appropriate length of stay. REQUIRED EDUCATION/TRAINING Must be currently licensed as a Registered Nurse in the state of employment with a minimum of 4 years clinical experience. Must be computer ...
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Pediatric Utilization Review Nurse to perform utilization reviews ensuring that HPSM’s pediatric members receive necessary medical care in a timely and cost-effective manner. This position will include the following essential duties & responsibilities: Conducts concurrent reviews of inpatient care, and reviews auth...
Judge Healthcare is actively seeking full time Utilization Review Nurses for one of the California's premier health systems!! This position is located in South San Francisco, CA!! The following qualifications must be met to be considered for this opportunity: License and Certification: Valid California license as a Registered Nurse (RN) or Licensed Vocational Nurse (LVN) Education and Experie...
Pediatric Utilization Review Registered Nurse Judge Healthcare is actively seeking a full time Pediatric Utilization Review Registered Nurse for California's largest hospital system!! This position is located in San Mateo, CA! The following qualifications must be met to be considered for this opportunity: Active RN license in the state of California BLS certification 1+ years of Pediatric 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...
Xerox is the world's leading enterprise for business process and document management. Its services, technology, and expertise enable workplaces - from small businesses to large global enterprises - to simplify the way work gets done so they operate more effectively and focus more on what matters most: their real business. Xerox offers business process outsourcing and IT outsourcing services, inclu...
Xerox is the world's leading enterprise for business process and document management. Its services, technology, and expertise enable workplaces - from small businesses to large global enterprises - to simplify the way work gets done so they operate more effectively and focus more on what matters most: their real business. Xerox offers business process outsourcing and IT outsourcing services, inclu...
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...
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...
Our client is currently seeking a Utilization Review Nurse . This job will have the following responsibilities: Reviews all request for specialty care, elective surgeries, treatment plans and diagnostic studies in accordance with commercial and senior health plan and CMS timelines. Utilizes health plan, Qualifications & Requirements: Active LVN/RN nurse licensure in the state of California M...
Utilization Review RN and LPN JFC Medical JFC’s client is seeking two contract nurses (LPN and RN) for their utilization management department. This client is a leading company in the healthcare industry. This company strives to provide superior care delivery by driving innovation throughout the health care system and have achieved tangible results. In this role, the position includes utilizati...
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 800 clients so they can support financial improvement, enhance the patient experience, and drive value-based performance. Through our revenue cycle management, patient communications, a...
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 800 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 Utilization Claims Review Nurse reviews and analyzes medical record and claims data, utilizing and applying Interqual Acute/Sub-acute Care Criteria and DRG coding practices to determine if inpatient admissions, observation stays, and ancillary services meet criteria. This position also maintains current information on regulatory guidelines as they pertain to acute and sub-acute levels of ...
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...
Utilization Review Nurse - Registered Nurse Area Hospital seeking Utilization Review Nurse. Utilization Review including assessment of medical records for appropriateness, level of care provided. Assess utilization of treatment, modalities, medications, services and application of treatment protocols. Interfaces with other members of the quality management health team to promote quality cost e...
Utilization Review (UR) Registered Nurse We are currently seeking out experienced Registered Nurses with experience in Utilization Review. These Nurses will be perform UR in the Hospital and Manage Care settings. You should be familiar and well versed in the assessment of medical records for appropriateness and the level of care provided. Other responsibilities include: assessing utilization o...
Job Description: Med-Scribe, Inc. has been finding top-notch candidates for our clients in the Rochester area since 1987. We began with medical office placements and have evolved to include entry-level administrative/clerical opportunities for well qualified candidates. After almost 30 successful years in Rochester, NY, placing administrative and healthcare specialists, we are coming home to BUFF...
Are you an experienced Utilization Review Nurse with case management skills? We are seeking UR Nurses for temporary, approx. 90 day positions in Chicago, IL. May lead to Full Time. The successful candidate must be knowledgeable of Milliman. Duties and responsibilities include, but are not limited to: Work with patients, families, other medical staff, and community agencies to determine the appro...
Are you an experienced Utilization Review Nurse with case management skills? We are seeking UR Nurses for temporary, approx. 90 day positions in Chicago, IL. May lead to Full Time. The successful candidate must be knowledgeable of Milliman. Duties and responsibilities include, but are not limited to: Work with patients, families, other medical staff, and community agencies to determine the appro...