- Actalent (Eugene, OR)
- …Essential Skills + Licensed Practical Nurse (LPN) or Registered Nurse ( RN ) certification. + Clinical review and prior authorization experience. ... Job Title: Clinical Review Nurse - Prior Authorization Job...+ Provide education to providers and/or interdepartmental teams on utilization processes to promote high-quality and cost-effective medical care… more
- Centene Corporation (Phoenix, AZ)
- …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure required Pay Range: ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The ...on department activities as assigned. Essential Skills + Clinical review + Utilization review + ... record Additional Skills & Qualifications + Current unrestricted Florida RN or LPN License. + Minimum of one year...or LPN License. + Minimum of one year of utilization review experience and discharge planning in… more
- Children's Mercy Kansas City (Kansas City, MO)
- …and directs the work of Nurse Case Managers, Social Workers, and Utilization Review specialist team members and support staff + Analyzes, evaluates, and ... and related software applications and implementations. + Engages in utilization review committee. Qualifications + Master's Degree...Performance Improvement Leadership + One of the following: Licensed RN - MO, Registered Nurse … more
- Medtronic (MN)
- …**Nice To Have** + 3 year's experience in case management, prior authorization or utilization review + Professional license or credentials (MA, LPN, RN ) ... to put patients first in everything we do. This position is remote to enhance our competitive edge and expand our cross-functional collaboration efforts.… more
- Insight Global (Boston, MA)
- …within a managed medical health plan. As a Regulatory & Compliance Oversight Nurse , you will play a key role in conducting audits, managing Corrective Action ... monthly audits using automated audit tools and Excel-based templates Review random samples of 5 case files per month...and Requirements Associates or Bachelors Degree in Nursing Active RN certification Minimum 5 years of clinical experience Prior… more
- Actalent (Cincinnati, OH)
- Job Title: Clinical Review Nurse 100% Remote Eastern and Central time zones Job Description The Review Nurse will be responsible for reviewing ... management, and discharge planning. + Proficiency with InterQual. + Active Compact RN /LVN/LPN License. + Utilization Management/Concurrent Review experience.… more
- Martin's Point Health Care (Portland, ME)
- …Works closely with the Manager Care Management, Director Health Management, Utilization Review managers/ supervisors, Quality Department staff, medical director ... experience. Required License(s) and/or Certification(s): + Current Licensure as an RN in Maine and other appropriate jurisdictions as necessary + CCM… more
- Centene Corporation (Jefferson City, MO)
- … utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required or RN license. Pay Range: ... on workplace flexibility. **Position Purpose:** Drafts correspondence letters based on review outcomes in accordance with National Committee for Quality Assurance… more
- Childrens Hospital of The King's Daughters (Norfolk, VA)
- …and/or Certifications + Registered Nursing License in the State of Virginia or Registered Nurse ( RN ) holding a valid Compact State license preferred. + ... Registered Nursing License in the State of Virginia, Registered Nurse ( RN ) holding a...+ Preferred Knowledge, Skills, and Abilities + Knowledge of utilization review and hospital finance processes preferred.… more