- Community Health Systems (Franklin, TN)
- **Job Summary** The Part-Time Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence...regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse -… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) who comprehensively ... this position is able to cover a multitude of utilization review functions through point of entry,...and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Medical Center Hospital (Odessa, TX)
- + Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician...A. Education: Holds a current Texas license as a Registered Nurse OR a current Texas Licensed… more
- Hunterdon Health Care System (Flemington, NJ)
- This is an in-person role. Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
- WestCare Foundation (Henderson, NV)
- Utilization Review Specialist Job...required Education: + Associates or Bachelors level LPN or RN and/or Bachelors or Masters level CADC/LADC with 2 ... years utilization review experience, preferred experience working with individuals with psychiatric or substance use disorder Experience and Competencies: +… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is ... responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD)… more
- HonorHealth (AZ)
- …different here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors ... Degree in Nursing from an accredited NLN/CCNE institution RequiredExperience3 years Registered Nurse in an acute care setting. Required1 year… more
- CaroMont Health (Gastonia, NC)
- …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case Management preferred. Minimum… more
- TEKsystems (Canoga Park, CA)
- …experienced RN or LVN with an active license to join our team as a Utilization Review Nurse . In this role, you will conduct retrospective reviews of ... activities in the system. Required Qualifications + Active RN or LVN license. + 3-5 years of experience...desirable). + Strong written communication and analytical skills. Position: Utilization Review Nurse Work Environment:… more
- TEKsystems (Canoga Park, CA)
- Position: Utilization Review Nurse Work...Job Description: We are seeking to hire an experienced RN or LVN with an active license to help ... address claims retro review . This role focuses on reviewing inpatient and outpatient...a managed care environment. Key Responsibilities: + Perform detailed utilization reviews for inpatient and outpatient claims. + Prepare… more