- Adecco US, Inc. (Houston, TX)
- Adecco Healthcare & Life Sciences is assisting a client hire a Utilization Review Nurse in Houston, TX! This role is in person / on site. Please read below and ... 8am to 5pm **Pay:** $85,00 to $110,000 yearly **Responsibilities of the Utilization Review Nurse :** . **Review Medical Records:** Thoroughly evaluate patient… more
- Elevance Health (Indianapolis, IN)
- ** Nurse Audit Sr.** **Hospital Billing - UB/IB Medical Records** **Program Integrity** **Virtual:** This role enables associates to work virtually full-time, ... is determined to recover, eliminate and prevent unnecessary medical-expense spending._ The ** Nurse Audit Sr.** is responsible for identifying, monitoring, and… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review/ utilization management experience in an HMO, MSO, IPA, or health plan ... readability scoring + Knowledge of the appeals process + Experience with audit preparation + Basic computer skills UCLA Health is a world-renowned health… more
- GE Vernova (NJ)
- …development initiatives including department conferences, training programs and onboarding. + Oversee Audit Board to ensure utilization by Internal Audit ... Description** **Job Description:** The Chief of Staff for Internal Audit at GE Vernova is a pivotal leadership role...drug coverage; access to a Health Coach, a 24/7 nurse -based resource; and access to the Employee Assistance Program,… more
- Molina Healthcare (Owensboro, KY)
- **JOB DESCRIPTION** For this position we are seeking a (RN) Registered Nurse who be licensed in the state they reside. We are looking for a RN Manager to manage a ... utilization management team supporting 14 Marketplace plans. Home office...and triage activities. + Ensures completion of staff quality audit reviews. Evaluates services provided and outcomes achieved and… 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
- Humana (Frankfort, KY)
- …our caring community and help us put health first** The Senior Compliance Nurse reviews utilization management activities and documentation to ensure adherence ... and to prevent and detect fraud, waste, and abuse. The Senior Compliance Nurse work assignments involve moderately complex to complex issues where the analysis of… more
- Molina Healthcare (Long Beach, CA)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... **JOB DESCRIPTION** **Job Summary** The **Delegation Oversight Nurse ** is responsible for ensuring that Molina Healthcare's...federal, NCQA, and any other applicable requirements. + Distributes audit results letters, follow up letters, audit … more
- Molina Healthcare (Albany, NY)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- STG International (Milledgeville, GA)
- …FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure ... (inspections) made by authorized government agencies as requested. + Audit nursing documentation in the clinical record for appropriate...+ Coordinate with the scheduler to ensure a Registered Nurse (RN) is on duty at least 8 hours… more
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