- Trinity Health (Des Moines, IA)
- …(https://www.genesishealth.com/ghg/) Join the MercyOne Family! We are looking to hire a Registered Nurse ! As a Registered Nurse at MercyOne, you will provide and ... Care Education:** Educating patients on preventive screenings, vaccinations, and Medicare benefits. + **Chronic Disease Management:** Providing guidance and support… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team....new staff to Federal laws and regulations pertaining to Medicare and Medi-Cal reimbursement. + Analyzes cases for referral… more
- 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 ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -...experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare , Medicaid,… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the largest… more
- New York State Civil Service (New York, NY)
- NY HELP Yes Agency Mental Health, Office of Title Registered Nurse 1 Psychiatric (NY HELPS), New York State Psychiatric Institute, Utilization review , P26749 ... 10032 Duties Description The selected candidate will provide Utilization Review services, including but not limited to conducting daily...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- US Tech Solutions (Columbia, SC)
- …A typical day would like in this role: Process prior authorization requests for Medicare Advantage line of business. Previous Medicare experience and /or UR ... with multiple applications to process authorization and appeals requests using Medicare criteria. **Responsibilities:** + Reviews and evaluates medical or behavioral… more
- US Tech Solutions (Chicago, IL)
- …experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff ... clinical policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. + Reviews… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ensure ... staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing… more
- Actalent (Eugene, OR)
- Job Title: Clinical Review Nurse - Prior AuthorizationJob Description This role involves analyzing prior authorization requests to assess the medical necessity ... criteria. + Collaborate with healthcare providers and authorization teams for timely review of services, including requests related to members. + Coordinate with… more
- Actalent (Eugene, OR)
- Job Title: Clinical Review Nurse - Prior Authorization Job Description This role involves analyzing all prior authorization requests to determine the medical ... + Licensed Practical Nurse (LPN) or Registered Nurse (RN) certification. + Clinical review and...determine the medical necessity of services. + Knowledge of Medicare and Medicaid regulations. + Knowledge of utilization management… more
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