- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... physician-founded, member-focused, and community-based not-for-profit health plan that offers high- quality affordable health insurance to members throughout New York.… 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 ... to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. * Develop and review...Duties as assigned. Essential Qualifications * Current Licensed Practical Nurse (LPN) or Registered Nurse (RN) with… more
- Zurich NA (Schaumburg, IL)
- Medical Bill Review Senior Nurse 127127 Zurich Insurance is currently looking for a **Medical Bill Review Senior Nurse ** to work from our Schaumburg, IL ... to customer inquiries quickly, accurately and in a professional manner. + Meet quality standards by adhering to Best Practices and participating in monthly peer … more
- 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 ... to status issue queries from patient financial services, coders, Quality and other entities. 10. Responsible for summary reports...3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review ,… 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...timely in order to ensure consistent expectations and maintain quality throughout the department. + Is required to ensure… 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 ... 1993. We provide flexible, cost-effective care management solutions that promote high- quality healthcare for members. **Position Summary** Join a team that's making… 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. ... documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established… 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 ... business hours remotely. Join Centene and help us deliver high- quality care and support to our Medicaid members across...with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive… 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 ... development and ongoing implementation of QM Work Plan activities. + Improve quality products and services, by using measurement and analysis to process, evaluate… more
- University of Utah Health (Salt Lake City, UT)
- …are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA_ This ... the patient and the organization through the provision of quality based patient care focusing on the medical necessity...admissions with associated levels of care and continued stay review . + Communication to third-party payers for initial and… more
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