- 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
- University of Utah Health (Salt Lake City, UT)
- …appropriateness of admissions with associated levels of care and continued stay review . + Communication to third-party payers for initial and concurrent clinical ... review . + Reviews patient chart to ensure patient continues...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Beth Israel Lahey Health (Boston, MA)
- …Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on ... of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for… more
- Zelis (St. Petersburg, FL)
- …Effective and proven leadership experience is a must as recommendations to the Nurse Reviewer 's regarding their claim management is required. Additionally, this ... you are. Position Overview The Sr. Supervisor, Clinical Chart Review is focused on supervising a team of Clinician's...as needed Quality Assurance and complete bi-annual assessment of Nurse Reviewer performance. Report these results to… more
- Fallon Health (Worcester, MA)
- …appeal to the Plan Medical Director, Center for Medicare/Medicaid Services, contracted reviewer , and the Plan contracted external review agency in accordance ... and member expectations. Under the direction of the Director, the Appeal Nurse represents, manages and oversees second level appeal cases (Office of Medicaid,… 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
- Hackensack Meridian Health (Hackensack, NJ)
- **The Advanced Practice Nurse (APN) utilizes a patient-centered coordinated care model, demonstrating competencies in leadership, direct clinical practice, ... nursing program. 2. Master's or Doctorate degree from an accredited Nurse Practitioner program. 3. Maintains clinical competencies through continuing education and… more
- AdventHealth (Orlando, FL)
- **Quality Review Nurse RN PRN Home Care AdventHealth Home Health** **All the benefits and perks you need for you and your family:** + Benefits from Day One + ... Home Care experience + OASIS experience + PDGM experience + Registered Nurse State Licensure and/or Compact State Licensure In Florida **Preferred qualifications:**… more
- CVS Health (OH)
- …high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position Summary** The Team Lead plays a ... sedentary work, including extended periods of sitting, computer use, and document review . + Participate in occasional on-call rotations, including some weekends and… more