- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical ... initiatives *Education*: * Attains and maintains current knowledge in UR/ UM practices, payer requirements, clinical guidelines, and.../*License/Certifications:*/ * Possession of a valid license as a Registered Nurse issued by the State of… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …TITLE: Utilization Review Clinician PAY RANGE: LVN/LPT $31.50-37.50 Per Hour RN /LCSW/LMFT/LPCC $54.00-64.00 Per Hour REPORTS TO: Director of Utilization Review ... ensure that extended stays are medically justified. + Payment Appeals : Prepare and submit appeals to third...Treatment Team on a daily basis and collaborate with clinical team to answer clinical questions related… more
- MVP Health Care (Tarrytown, NY)
- …York** **Qualifications you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 ... maintain cost-effectiveness and manage Medical Loss Ratio (MLR). + Appeals & Denials: Participate in the appeals ...+ Training & Support: Educate staff and providers on UM protocols, documentation standards, and clinical guidelines.… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …as assigned. Essential Qualifications * Current Licensed Practical Nurse (LPN) or Registered Nurse ( RN ) with state licensure. Must retain active and ... care. * Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. *...within managed care setting. * 3+ years' experience in clinical nurse setting preferred. * TPA Experience… more
- Brighton Health Plan Solutions, LLC (NC)
- …regulatory and accreditation requirements. * Duties as assigned. Essential Qualifications * Current Registered Nurse ( RN ) with state licensure. Must retain ... care. * Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. *...within managed care setting. * 3+ years' experience in clinical nurse setting preferred. * TPA Experience… more