- Emory Healthcare/Emory University (Atlanta, GA)
- …_development,_ and leadership programs + And more **Description** The ** Utilization Review (UR) Specialist** is a Registered Nurse responsible for conducting ... when necessary, discussions with the provider team and/or Medical Director of UR. + Primary duties and responsibilities: Operational...experience or a minimum of two years of previous utilization review experience. + Licensure - Must… more
- AmeriHealth Caritas (LA)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
- AmeriHealth Caritas (Washington, DC)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Current driver's license required… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... to hire) **Job Description:** + NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral… more
- Ascension Health (Milwaukee, WI)
- …initiatives. + Develop systems and process for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to ... **Details** + **Department:** Utilization Management + **Schedule:** Full Time, Partially Remote...clients. **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date or job transfer… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... appropriateness and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review … more
- Actalent (Sunrise, FL)
- …UMN assists in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ... Actalent is hiring a Utilization Management Nurse ! Job Description The...on department activities as assigned. Essential Skills + Clinical review + Utilization review +… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director /Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical ... improvement programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. + Performs… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale ... co-workers, families, peers, and other health team members. Submits all concerns through Utilization Management Director ; be able to identify, analyze and make… more