- Sedgwick (Phoenix, AZ)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and ... colleague technical and quality activities with a focus on trends and ...business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required.… more
- 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 (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)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry ... and concurrent medical record review for medical ...medical documentation that accurately reflects intensity of services, quality and safety indicators and patient's need to continue… 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
- 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 (Eugene, OR)
- Job Title: Clinical Review Nurse - Prior Authorization Job Description This role involves analyzing all prior authorization requests to determine the medical ... requirements. The successful candidate will provide recommendations to the medical team to promote quality and cost-effectiveness...+ Licensed Practical Nurse (LPN) or Registered Nurse (RN) certification. + Clinical review and… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... and competent manner. Processes all prior authorizations to completion utilizing appropriate review criteria. Identifies and refers all potential quality issues… more
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