- UCLA Health (Los Angeles, CA)
- …including inspections of clinical areas, patient care practices, and administrative processes + Review medical records of services in preparation for health plan ... Description The Quality Management Nurse is responsible for...and safety. In this role, you will supports all Medical Group Health Education & Disease Management Programs utilizing… more
- The County of Los Angeles (Los Angeles, CA)
- …REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse * or Medical Service Coordinator, CCS.** -OR- OPTION ... UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333)...needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review… more
- CVS Health (Columbus, OH)
- …lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and… more
- CVS Health (Boise, ID)
- …skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and ... quality and metric expectations. **Required Qualifications** + Registered Nurse (RN) - active license. + 3+ Years of...Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. +… more
- Houston Methodist (Houston, TX)
- …This position has achieved an expert level at all objectives delineated in the Utilization Review Nurse and Utilization Review Specialist Nurse job roles ... At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is...Functions as a resource to department staff in communicating medical information required by external review entities,… 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 ... technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical ...Determines need for and conducts in-service training to improve quality of admission and continued stay reviews, and to… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring the ... receipt of high quality , cost efficient medical outcomes for those...authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies… 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 ... concurrent medical record review for medical ...necessary to resolve progression-of-care barriers through appropriate administrative and medical channels. ** QUALITY /SAFETY ESSENTIAL FUNCTIONS** + Participates… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial… more
- Actalent (Sunrise, FL)
- …staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, ... Utilization Management Nurse !Job Description The Utilization Management Nurse ...standardized Review Criteria. + Coordinate with the Medical Director/Physicians for requests outside standard Review … more
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