- Actalent (Austin, TX)
- Clinical Review Nurse - Concurrent Review Location: Remote - Compact Nursing License required; must be able to work CST hours Schedule: Tuesday-Friday, 10:00 ... Business Unit: Medicaid About the Role We are seeking a Clinical Review Nurse to perform concurrent reviews for Medicaid members, ensuring appropriate care,… 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
- Centene Corporation (Tallahassee, FL)
- …a fresh perspective on workplace flexibility. Centene is hiring a **Remote Concurrent Review Nurse ** to support our **Florida Medicaid** line of business. This ... Florida nursing license** (or compact license valid in FL). + **Concurrent review experience** in a managed care or hospital/facility setting. + Ideal candidates… more
- Centene Corporation (New York, NY)
- …license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- Actalent (Orlando, FL)
- Clinical Review Nurse - Concurrent Review Location: Remote - Candidates can be live anywhere in the US but must be able to work CST hours Schedules ... 6:30 PM CST Position Overview We are seeking Clinical Review Nurses to join our remote team. In this...assess member health, care setting, and medical necessity + Review acuity, resource use, length of stay, and discharge… 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 ... with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… 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 ... 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
- 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 necessity and level of care using...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… 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 ... standards by adhering to Best Practices and participating in monthly peer review audits. + Ensure legal compliance by following regional, country and/or local… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the ... Nurse issued by the State of Minnesota. **Title:** *Staff Nurse - Utilization Review (ED)* **Location:** *MN-Minneapolis-Downtown Campus* **Requisition ID:**… more