- Albany Medical Center (Albany, NY)
- …America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. * Completes ... Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions and continued stays, and documents… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry ... and concurrent medical record review for medical ...medical documentation that accurately reflects intensity of services, quality and safety indicators and patient's need to continue… 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 ...Determines need for and conducts in-service training to improve quality of admission and continued stay reviews, and to… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, ... guidelines and evidence-based practice * Quality of Practice*: * Promotes quality through evidence-based utilization review processes and actively contributes… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt of high ... quality , cost efficient medical outcomes for those...authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies… more
- 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 ... coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial… more
- YesCare Corp (Brentwood, TN)
- …and retrospective review . + Track, trend and evaluate appropriateness and quality of care issues with the implementation of education to internal and external ... standards and standards of best practice. + Facilitate quality health care intervention recommendations. + Review ...review parameters under the direction of the YesCare Medical Director. + Identify and document comparisons with community… 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 ... management Assistants. 4. Reviews and documents findings on all medical necessity and status denials. 5. Works closely with...3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review ,… more
- UCLA Health (Los Angeles, CA)
- …for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical ... Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role...protocols and national clinical guidelines (eg, InterQual, Milliman) in review decisions. + Coordinates escalations to medical … more
- Centene Corporation (Tallahassee, FL)
- …Reside in Florida!** **Centene is Hiring!** **We're looking for a Remote Concurrent Review Nurse to support our Medicaid team.** **Ideal Candidate:** + **Has ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more