- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... service are met and is subject to closure without prior notice. ABOUT LOS ANGELES COUNTY DEPARTMENT OF HEALTH...medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services… more
- Ascension Health (Elk Grove Village, IL)
- …issues prior to patient's discharge. + Maintain accurate records of review activities, ensuring reports and outcomes of clinical documentation improvement ... **Details** + **Department:** Clinical Documentation + **Schedule:** Full-time, Monday to Friday...activities. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Illinois Board of Nursing obtained… more
- CDPHP (Latham, NY)
- …Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This includes approval ... with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- Intermountain Health (Denver, CO)
- …supplies, and resources. + **Evaluate:** Evaluates patient response to interventions through review of achievement of goals, clinical outcomes, patient, and ... **Job Description:** The Registered Nurse (RN) is a professional caregiver who assumes...description's last update on 4/27/2025. Employees hired or promoted prior to this date will be held to the… more
- Actalent (Sunrise, FL)
- …internal process development, and provide education to the team on utilization review -related issues. Responsibilities + Review prior authorization requests ... NurseJob Description We are seeking a dedicated Utilization Management Nurse (UMN) who will work collaboratively with an interdisciplinary...Utilization management + Behavioral Health + Mental Health + Clinical review + Utilization review … more
- Actalent (Sunrise, FL)
- …of care, maintaining high provider and patient satisfaction. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, ... Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse...management, behavioral health, and mental health. + Proficiency in clinical and utilization review processes. + Current… more
- Justice, Bureau of Prisons/Federal Prison System (Rochester, MN)
- …a Bureau of Prisons, Medical Referral Center (MRC). Serves as the Utilization Review Nurse and assists in quality improvement activities through data collection, ... Utilization Review Committee. Applies predetermined evidence-based criteria sets and clinical practice guidelines when reviewing patient care in an effort to… more
- University of Utah Health (Salt Lake City, UT)
- …stay review . + Communication to third-party payers for initial and concurrent clinical review . + Reviews patient chart to ensure patient continues to meet ... expected cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- US Tech Solutions (May, OK)
- … clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews ... and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. . Considers all documented...Nurse in state of residence . Must have prior authorization utilization experience . Able to work in… more
- Sanford Health (Rapid City, SD)
- …planning, facilitation and coordination of discharge needs. Enhances the quality of clinical outcomes and patient satisfaction while managing the cost of care. ... and population specific standards as designated in their assigned clinical setting. Cares for patients in all phases of...and standards of nursing practice as outlined in the Nurse Practice Act and Administrative Rules in state of… more
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- University of Utah (Salt Lake City, UT)