- Trinity Health (Des Moines, IA)
- …Des Moines Join the MercyOne Family! We are looking to hire a Utilization Review RN! Responsible for the review of inpatient and outpatient admission records ... Management staff utilizing admission criteria guidelines-and second level physician review process when appropriate. Interacts with insurance providers to obtain… more
- Humana (Columbus, OH)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more
- Catholic Health Initiatives (Houston, TX)
- …assist in determination of clinical appropriateness for level of care and Medicare /Medicaid and Managed Care related issues 3. Reviews all patient documentation in ... of 89 JOB DESCRIPTION MASTER TEMPLATE 6. Educates staff with updates in Medicare Medicaid and Managed care initiatives 7. Initiates and Coordinates orientation for… more
- US Tech Solutions (Chicago, IL)
- …clinical policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. + Reviews ... of Care cases across all lines of business (Commercial and Medicare ). + Independently coordinates the clinical resolution with internal/external clinician support… more
- Martin's Point Health Care (Portland, ME)
- …a "Great Place to Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as is responsible for ensuring the receipt of high quality, ... services, notification of emergent hospital admissions, completes inpatient concurrent review , establishes discharge plans, coordinates transitions of care to… more
- US Tech Solutions (May, OK)
- …clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews ... of Care cases across all lines of business (Commercial and Medicare ). . Independently coordinates the clinical resolution with internal/external clinician support… more
- Humana (Annapolis, MD)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Evening + Nursing + Req ... 22, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the appropriate use of healthcare… more
- HCA Healthcare (Richmond, VA)
- …Do you have the career opportunities as a Revenue Integrity Clinical Charge Review Analyst RN you want with your current employer? We have an exciting ... of colleagues. Do you want to work as a Revenue Integrity Clinical Charge Review Analyst RN where your passion for creating positive patient interactions is valued?… more
- Centene Corporation (Atlanta, GA)
- …a fresh perspective on workplace flexibility. **Centene is Hiring: Clinical Review Clinicians - Appeals (Ambetter Market)** Centene is currently hiring **two ... Clinical Review Clinicians - Appeals** to support our **Ambetter Market**...- 4 years of related experience. Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management… more
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