- Houston Methodist (Houston, TX)
- …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 ...and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Ascension Health (Tulsa, OK)
- …processes and procedures. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Oklahoma Board of Nursing ... claims , qualityindicators and other risk-related data. + Coordinate the medical staff's professional performance evaluation and peer review programs in… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... protocol sets, or clinical guidelines and provide support and review of medical claims and...customer service skills required. **Minimum License Requirement :** California RN license. Delivering world-class health care one patient at… more
- InGenesis (Columbia, SC)
- InGenesis is currently seeking a Registered Nurse / RN - Managed Care Coordinator to work for our client located in Columbia, SC. In this role you will ... any questions you may have. Job Duties * Perform medical review /authorization process. * Ensure coverage for...Perform other duties as assigned. Minimum Qualifications * Current Registered Nurse / RN license… more
- Molina Healthcare (San Antonio, TX)
- For this position we are seeking a ( RN ) Registered Nurse who...for a RN with experience with appeals, claims review , and medical coding. ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- TEKsystems (Canoga Park, CA)
- …Perform comprehensive utilization reviews for inpatient and outpatient claims . + Prepare medical records for review by medical directors and provide ... active license to join our team as a Utilization Review Nurse . In this role, you will...you will conduct retrospective reviews of inpatient and outpatient claims to ensure medical necessity, compliance, and… more
- CVS Health (Austin, TX)
- …and every day. **Position Summary** This Case Manager - Registered Nurse ( RN ) position is with Aetna's National Medical Excellence (NME) team and is a ... to apply, however, preference is for candidates in compact Registered Nurse ( RN ) states. This...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- US Tech Solutions (Columbia, SC)
- …available resources to promote quality, cost effective outcomes. + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate ... temp to hire)** **Job Description:** + Must be an RN in SC and have an active and unrestricted...weeks remote position after training. + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria… more
- The County of Los Angeles (Los Angeles, CA)
- …be active and unrestricted. Successful candidates are required to provide proof of their Registered Nurse ( RN ) License and Basic Life Support (BLS) ... REGISTERED NURSE I/RELIEF NURSE ...vaccination against COVID-19 or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates… more
- The County of Los Angeles (Los Angeles, CA)
- …REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse * or Medical Service Coordinator, CCS.** -OR- OPTION ... II: Two (2) years of experience as a registered nurse , of which one year must...may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN … more