- AmeriHealth Caritas (Dover, DE)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… 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, ... and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based ... to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards,...+ A minimum of three years of experience in utilization management , preferred + Team leading or… more
- Trinity Health (Troy, NY)
- …requirements for Utilization Management and works collaboratively with Utilization Management /Concurrent Review Nurse , physicians, staff and ... Upon identification of possible concurrent denials, forwards information to the appropriate Utilization Management /Concurrent Review Nurse within… more
- Matrix Providers (Aurora, CO)
- Utilization Review Nurse (RN) Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... and fair, reliable schedules. Matrix Providers is hiring a Utilization Review Nurse (RN) to...(Outlined in Handbook) + 401(k) Plan Minimum Requirements Registered Nurse (RN) Utilization Management : Degree/Education:… more
- Beth Israel Lahey Health (Burlington, MA)
- …difference in people's lives.** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... the level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure… more
- 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 ... 5pm **Pay:** $85,00 to $110,000 yearly **Responsibilities of the Utilization Review Nurse :** . **...in Texas . 2 to 3 years of clinical nurse /case management experience . 2 to 3… more
- Elevance Health (Woodbridge, VA)
- RN Utilization Review Nurse (Washington DC...is located at 609 H. Street NE. The **Medical Management Nurse ** is responsible for review ... scope of licensure the District of Columbia is required. **Preferred Qualifications:** + Utilization Management / Review in managed care strongly preferred. +… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** ... + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Milford Regional Medical Center (Milford, MA)
- …with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at MRMC. The UR ... year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria more
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