- Monroe Plan for Medical Care (Albany, NY)
- Utilization Reviewer RN Summary Title: Utilization Reviewer RN ID:UM41-ALBANY Location:Albany Job Type:Full-time Date Posted:04/17/2025 Openings:1 ... HAS DIRECT REPORTS:NoESSENTIAL JOB DUTIES/FUNCTIONS % of Time Essential Function 75 Utilization Review Functions Perform utilization review … more
- LifePoint Health (Las Cruces, NM)
- …**Nursing* **Organization:** **Memorial Medical Center* **Title:** * Registered Nurse ( RN ) - Utilization Review - Full Time* **Location:** *New ... Here, you're not just valued as an employee, but as a person. As a registered nurse ( RN ) joining our team, you're embracing a vital mission dedicated to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
- Community Health Systems (Naples, FL)
- …meet deadlines. + Effective written and verbal communication skills. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact ... **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition… more
- AmeriHealth Caritas (Charleston, SC)
- …licensure/independent licensure required: LPC, LCSW, LISW, LICSW, LCMHC, LMHC, LMFT or RN ( Registered Nurse graduated from an accredited institution ... Under the direction of the Supervisor, the Behavioral Health Utilization Management Reviewer is responsible for completing...all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer… more
- Geisinger (Danville, PA)
- …information, suggests alternatives and assists in ensuring documentation integrity. + Enters utilization review data into database for tracking and trending ... Experience Minimum of 3 years-Nursing (Required) Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania OUR PURPOSE… more
- Atlantic Health System (Morristown, NJ)
- …Assists in identification and collection of avoidable days 7. Coordinates with the CM RN and/or CMA to identify and complete the process for CMS required patient ... notices. 8. Completes and documents utilization reviews, physician advisor referrals and other communications related to assigned cases in accordance with department… more
- US Tech Solutions (Canton, MA)
- …required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is expected to function independently in her / ... complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical...the job** + Bachelor's degree in Nursing, preferred + Registered Nurse with current a and unrestricted… more
- Crouse Hospital (Syracuse, NY)
- …outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse ( RN ) to track and manage data and client ... requires 6 weekends a year). Utilization Management Registered Nurse ( RN ) Position Responsibilities:...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… more
- Ascension Health (Baltimore, MD)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more