- Providence (Irvine, CA)
- **Description** ** RN Utilization Review at Irvine, CA. This position is Full- time and will work Remote 8-hour, Day shifts.** Provide prospective, ... Management , medical necessity, and patient status determination. The Utilization Management RN must effectively...Qualifications:** + Associate's Degree Nursing. + Upon hire: California Registered Nurse License + 2 years experience… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** ... + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The...+ Current license to practice as a Registered Nurse in the State of Utah,… more
- UNC Health Care (Hendersonville, NC)
- … reviews in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities: + Uses approved criteria and conducts ... referrals. Initiates appropriate social work referrals. + Performs utilization management assessments and interventions, using collaboration...Required + Must be licensed to practice as a Registered Nurse in the state of North… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC...**_REQUIRED EDUCATION/EXPERIENCE_** **:** + Current Texas licensure as a Registered Nurse ( RN ).with a minimum ... efficient use of medically appropriate services. Integrates and coordinates utilization management activities, care coordination, discharge planning functions,… more
- Providence (Mission Hills, CA)
- … Utilization Management , medical necessity, and patient status determination. The Utilization Management RN must effectively and efficiently manage a ... **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical...**Required Qualifications:** + Associate's Degree in Nursing. + California Registered Nurse License upon hire. + 2… more
- Providence (Olympia, WA)
- **Description** The Utilization Review (UR) Nurse ...or Associate's Degree in Nursing + 3 years - Utilization Review , Care Management , Quality ... a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination.… more
- 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, ... payers to resolve care coordination issues. Qualifications: * Education: Registered Nurse ( RN ) license required;...nursing experience (acute care preferred). o Prior experience in utilization review , case management , quality… more
- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... support to the hospital and treatment team throughout the review of patients, their placement in various levels of...Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker… more
- Albany Medical Center (Albany, NY)
- …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG...with Triad Team and health care team. Minimum Qualifications:* Registered nurse with a New York State… more
- US Tech Solutions (Columbia, SC)
- …the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) **About US Tech ... established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to… more