- UNC Health Care (Kinston, NC)
- …the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established criteria ... 3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review ,...Registered Nurse required. + 2 years utilization review , care management, or compliance experience preferred. + Minimum… more
- HCA Healthcare (Houston, TX)
- …you, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. Our team will promptly review your application. Highly qualified ... our colleagues in their positions. Join our Team as a(an) Registered Nurse Clinical Reviewer and access programs to assist with every stage of your career.… more
- Naven Health (Nashville, TN)
- …teammates, and the patients we serve. **Job Description Summary:** The Quality Assurance Chart Review Nurse is responsible for the review of assigned ... clinical records. The Quality Assurance Chart Review Nurse works closely with the Quality Assurance Team to identify documentation discrepancies and deficiencies… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in ... appropriate parties/departments. * Collaborates with healthcare partners to ensure timely review of services and care. * Provides referrals to Case management,… more
- YesCare Corp (Brentwood, TN)
- …that is transforming lives through care and expertise. **Key Responsibilities:** + The nurse will focus on what's best for the patients within assigned contracts and ... involved in the implementation of a comprehensive outpatient/inpatient review process utilizing criteria based review standards and standards of best practice… more
- Emory Healthcare/Emory University (Decatur, GA)
- …_,_ and leadership programs + And more **Description** We're seeking a **Clinical Utilization Review Nurse Preceptor (Registered Nurse / RN)** . This ... responsible for training, mentoring, and coaching for the Utilization Review Department and must be an expert in the...Department and must be an expert in the utilization review functions and able to cover any role at… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. This ... documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established… more
- CVS Health (Columbus, OH)
- …the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital role ... ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position offers the… more
- Centene Corporation (Phoenix, AZ)
- …benefits including a fresh perspective on workplace flexibility. Centene is seeking a **Clinical Review Nurse ** to join our **Arizona Medicaid team** in a fully ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… 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