- Martin's Point Health Care (Portland, ME)
- …as 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 ... reviews for retrospective authorization requests as well as claims disputes.The Utilization Review Nurse will use appropriate governmental policies as well as… more
- Molina Healthcare (Tacoma, WA)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of previously denied ... these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… more
- HCA Healthcare (Richmond, VA)
- …reviews, and patient audits as needed. **Qualifications that you will need:** + Registered Nurse Degree required. + Minimum 1 year directly related Healthcare ... **Introduction** Do you have the career opportunities as a Revenue Integrity Clinical Charge Review Analyst RN you want with your current employer? We have an… more
- Medical Mutual of Ohio (OH)
- …Ohio State Nursing Board. Bachelor's degree preferred. + 3 years experience as a Registered Nurse in acute care, critical care, emergency medical or medical ... medical coding or medical documentation investigation preferred. **Professional Certification(s):** + Registered Nurse with current State of Ohio unrestricted… 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 + ... 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
- Centene Corporation (Sacramento, CA)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... a fresh perspective on workplace flexibility. This position requires RN California Licensure and for candidates to have a...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- Trinity Health (Columbus, OH)
- …accredited school of nursing. + Licensure / Certification: Current license to practice as a Registered Nurse ( RN ) in the State of Ohio. + Experience: Three ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** RN , Utilization Review Case Manager** **Why Mount Carmel?** With five hospitals… more
- 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 ... technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one...CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board… more
- BAYADA Home Health Care (Rutland, VT)
- BAYADA Home Health Care is currently seeking a **Clinical Manager ( RN required)** to join our **Rutland, VT** ** Medicare Certified Home Health office.** ... cohesive and consistent management of all field staff. + Review all clinical documentation to ensure consistent, accurate, high-quality...Manager:** + 2or more years of experience as an RN in Home Health. + Oasis experience required. +… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse ( RN ) who comprehensively plans for case management of a target ... department and the hospital. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more