- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... resource to the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs & NCDs). This position… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …+ And more **Description** We're seeking under the direction of the ** Utilization Management Appeals Professional, Registered Nurse ** is responsible for managing ... duties and responsibilities: Participates in external reviews such as Medicare Recovery Audit Program or other third-party audit programs and defends Emory… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry ... of the URN, this position is able to cover a multitude of utilization review functions through point of entry, observation progression of care management, concurrent… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support staff from ... onboardings with time sensitive requirements. + Support and grow the utilization management team through strong professional relationships, mentorship, modelling of… more
- Corewell Health (Southfield, MI)
- Scope of Work This role includes accountability for utilization review (UR) and may include admission, concurrent, and retrospective reviews. Coordinates activities ... adequate and complete documentation received by the physician/provider and utilization reviews. Initiates concurrent appeals to address patient class/status… more
- Trinity Health (Des Moines, IA)
- …Des Moines Join the MercyOne Family! We are looking to hire a Utilization Review RN! Responsible for the review of inpatient and outpatient admission records ... STAR admitting system. ESSENTIAL FUNCTIONS: + Conducts admission review per the Utilization Management Plan to ensure that the hospitalization is approved based on… more
- Sharp HealthCare (San Diego, CA)
- …Degree in Nursing; Bachelor's Degree in Nursing; Master's Degree; California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Case Manager (CCM) ... acute care or clinical experience in area of specialty. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred Qualifications** + Master's… more
- LifePoint Health (Hickory, NC)
- *Registered Nurse (RN), Clinical Case Manager* PRN * * *Your experience matters* At Frye Regional Medical Center, we are driven by a profound commitment to ... an employee, but as a person. As a *registered nurse (RN)* joining our team, you're embracing a vital...outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of… more
- Molina Healthcare (Oakland, CA)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... agreement. Preservice and outpatient experience. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- STG International (Milledgeville, GA)
- STGi is seeking a Licensed Practical Nurse /Licensed Vocational Nurse to provide services to our Georgia War Veterans Home. JOB SUMMARY: The primary purpose of ... FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure… more