- 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
- AdventHealth (Altamonte Springs, FL)
- …collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...(ROM), and quality. . Completes accurate and timely record review to ensure the integrity of documentation compliance. .… more
- Zelis (St. Petersburg, FL)
- …maintain bill review content, including but not limited to DRG Reviewer Rationales, DRG Clinical Validation Policies, CCR Review Guidelines and Templates, ... of facility and provider disputes as they relate to DRG validation, itemized bill review , and/or clinical claim review Expert Claim Review . They will… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… 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
- Emory Healthcare/Emory University (Atlanta, GA)
- …mentorship, _development,_ and leadership programs + And more **Description** The **Utilization Review (UR) Specialist** is a Registered Nurse responsible for ... and hospital. + Compliance: 1. Will identify and complete Medicare Outpatient Observation Notices (MOON), Medicare Change...or a minimum of two years of previous utilization review experience. + Licensure - Must have a valid,… 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