- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring ... Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day… more
- Ascension Health (St. Charles, IL)
- **Details** + **Department:** Utilization Review + **Schedule:** Part-Time, Partially Remote, Monday - Friday; 9am - 1pm. + **Hospital:** Ascension Saint Joseph ... Provide health care services regarding admissions, case management, discharge planning, and utilization review . + Review admissions and service requests… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating care for ... benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer is...+ Licensure in additional states a plus. + For registered nurses only: a bachelor's degree in (BSN) preferred.… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
- Dartmouth Health (Lebanon, NH)
- …leadership, communication and computer skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote:Fully Remote * ... Area of Interest:Nursing * Pay Range:$79,747.20/Yr. - $127,587.20/Yr. (Based on 40 hours per week, otherwise pro rata) * FTE/Hours per pay period:.01 hrs/per week (per diem/temp) * Shift:Rotating * Job ID:35880 Dartmouth Health offers a total compensation… more
- AmeriHealth Caritas (Washington, DC)
- …(BSN) preferred + Minimum of 3 years of diverse clinical experience as a Registered Nurse in an Intensive Care Unit (ICU), Emergency Department (ED), ... reviews within a managed care organization preferred **Licensure** + Active and unencumbered Registered Nurse license in the District of Columbia + Valid and… more
- Katmai (Fort Carson, CO)
- …or American Red Cross. + Three (3) years within the last four (4) years as a registered nurse in utilization management. + One (1) year of experience in ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization...full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate… more
- McLaren Health Care (Port Huron, MI)
- …related duties as required and directed. **Qualifications:** Required ⦁ State licensure as a registered nurse ( RN ) ⦁ Bachelor's degree in nursing from ... **Department:** Utilization Review **Daily Work Times:** 8:00am-4:30pm **Hours Per Pay Period:** 40 **Position Summary:** Responsible for determining the… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized… more
- Penn Medicine (Lancaster, PA)
- …NCLEX within 60 days of starting in their RN role. + A graduate registered nurse may only practice professional nursing under supervision and if the graduate ... that established outcomes are achieved through availability and appropriated utilization + of human, material and financial resources. +...their NCLEX within 60 days of starting in their RN role.A graduate registered nurse … more