- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance ... and continued patient stays with Attending Physician, Physician Advisor, Inpatient Nurse Care Manager, and insurance/payer. + Collaborates with Revenue Cycle to… more
- Elevance Health (Louisville, KY)
- **Clinical Review Nurse I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... Medicare and Medicaid Services to transform federal health programs. The **Clinical Review Nurse ** is responsible for reviewing and making medical determinations… more
- CVS Health (Salt Lake City, UT)
- …a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and plan language ... thinking, evidenced based clinical criteria and clinical practice guidelines. Med Review nurses use specific criteria to authorize procedures/services or initiate a… more
- US Tech Solutions (Chicago, IL)
- …experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff ... policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. +...3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior… more
- UNC Health Care (Kinston, NC)
- …the right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care, ... movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care delays/issues as… more
- Centene Corporation (Sacramento, CA)
- …current CA license **Must have** **5-7 years related** **experience in UM-Concurrent Review . 2+ years of acute care experience required. 10% Travel Yearly ... teams on projects within utilization management as part of the clinical review team + Partners and works with Medical Affairs and/or Medical Directors… more
- Centene Corporation (New York, NY)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... care to members + Provides feedback on opportunities to improve the authorization review process for members + Performs other duties as assigned + Complies with… more
- Centene Corporation (Olympia, WA)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers on utilization… more
- Ascension Health (Baltimore, MD)
- …plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance ... care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and service requests within… more