- George C. Grape Community Hospital (Hamburg, IA)
- Quality/Utilization Review Nurse Position Summary: The Quality/Utilization Review Nurse is responsible for evaluating the medical necessity, ... and cost-effective care. Additionally, this position oversees the Infection Control Nurse to ensure adherence to infection prevention protocols and regulatory… more
- Molina Healthcare (NE)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment ... supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have strong organizational… more
- Centene Corporation (Indianapolis, IN)
- …duties as assigned + Complies with all policies and standards We are seeking a Clinical Review Nurse - Concurrent Review to join our team! The ideal ... care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member...candidate will bring expertise in: + Nurse with a IN or Compact State License +… 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...Department and must be an expert in the utilization review functions and able to cover any role at… more
- 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 (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