Utilization Management RN: Care Coordination & Review
CommUnityCare
Community Care is seeking a Registered Nurse to perform utilization review and coordinate care for members across the health care continuum. You will assess medical necessity, document decisions, and collaborate with physicians and care teams to optimize outcomes. In this role, you will review outpatient, inpatient, and post-acute services, communicate findings to providers, and participate in quality improvement initiatives. #J-18808-Ljbffr
- ...City) full time days and every other weekend RN Case Manager -Utilization Review at INTEGRIS Health, Oklahoma City, OK. Get... ...all available resources. Recommends and coordinates timely transfers to appropriate levels of care as indicated by clinical needs and utilization...SuggestedFull timeWork at officeRemote workWeekend work
- ...Humana seeks an experienced Utilization Management RN to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care. You will work with providers and members to facilitate care and ensure appropriate...SuggestedRemote work
$26.01 - $56.14 per hour
...passionate colleagues who care deeply, innovate... ...medical management organization founded... ...medical journeys. As a Utilization Management (UM)... ...specializing in Medical Review, you’ll play a... ...to implement, coordinate, monitor and evaluate... ..., unrestricted RN license in your state...SuggestedHourly payFull timeTemporary workLocal areaRemote workMonday to FridayFlexible hoursShift work$35 - $40 per hour
Sagility is hiring an RN Utilization Management Reviewer to perform day-to-day clinical and service authorization reviews for medical necessity, ensuring CMS compliance in decision-making. Requires RN license in Massachusetts, Associate degree minimum (Bachelor's preferred...SuggestedRemote jobHourly payShift workWeekend work- Currently seeking a Utilization Management RN . Please see details and qualifications below... ...advanced clinical judgment to review medical records, validate care plans, and authorize services that... ...with providers, support care coordination, ensure regulatory compliance, and...SuggestedImmediate startRemote workWeekend workDay shift
$35 - $40 per hour
...service offerings for clinical, case management, member engagement, provider... ...employees across 5 countries. Job title: RN Utilization Management Reviewer Job Description: We are currently hiring... ...): 2 or more years of Home Health Care experience 2 or more years working in...Hourly payTemporary workCurrently hiringRemote workMonday to FridayFlexible hoursWeekend work$35 - $40 per hour
...service offerings for clinical, case management, member engagement, provider... ...containment, and analytics. Job Title RN Utilization Management Reviewer Responsibilities Conduct timely clinical... ...through written notification to primary care team, specialty providers, vendors,...Hourly payTemporary workRemote workMonday to FridayFlexible hoursWeekend work$63k - $94k
...Remote Utilization Review Registered Nurse (UR RN) Are you an experienced RN looking to transition away... ...making a massive impact on patient care? We are seeking a dedicated... ...physician advisor referrals. Denial Management & Appeals: Coordinate the Peer-to-Peer (P2P) process...Work at officeRemote work10 hours per weekFlexible hoursShift workWeekend workAfternoon shift3 days per week- ...integrated health care plans and related... ...LTSS department. RN will be responsible... ...for providing case management services and evaluating... ...and concurrent review. Provides monthly... ...setting by utilizing the applicable medical... ...providers for care coordination. Works with medical...Contract workRemote workMonday to FridayFlexible hours
$75k - $100k
...Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness... ...to provide judgment to review medical services with evidence... ...objectives of quality care and reasonable cost. Would... ...Demonstrated experience managing and coordinating care effectively for case...For contractorsWork at officeLocal areaImmediate startRemote work- ...DescriptionJob Description Job Title: RN Utilization Review Position Summary We are seeking a... ...and collaborate with providers and care teams. Responsibilities Review... ...appropriate resource utilization. Coordinate with case management and insurance teams as needed. Document...
$70.2k - $120.4k
...deliver personalized health care experiences and partner... ...community of connected care, where coordinated, quality service is the... ...member feels valued. The Utilization Review RN will review and document member... ...policies and utilization management and/or clinical appeals...Full timeWork experience placementRemote work- ...Software, Inc. seeks an experienced Utilization Review RN to perform prospective,... ...necessity and appropriate levels of care. The role includes coordinating care, discharge planning, and addressing... ...experience and may have Case Management certification in progress or preferred...Remote work
- ...Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will collaborate with the... ...to ensure appropriate, cost-effective care at the right level. Requirements include a CA LVN/RN license, minimum 3 years in case management...Remote work
- ...CVS Health is seeking a Utilization Management Nurse Consultant (Remote) to support Florida Medicare home-care requests. You will review cases, determine coverage, and coordinate with providers to ensure timely... ...position requires an active RN license, 2+ years of experience...Full timeRemote work
- HealthEdge Software, Inc. is seeking a motivated Utilization Review RN to perform prospective, concurrent, and retrospective review... ...ensure medical necessity and appropriate level of care. This role involves coordinating discharge planning and addressing appeals initiated...Remote jobContract work
- Optum is seeking a Per Diem Utilization Management Nurse to review medical records and craft defensible appeal letters. You will extract pertinent case details, adhere to HIPAA, and follow OPAS/Optum guidelines while meeting time expectations. The role offers telecommuting...Remote jobDaily paidLocal area
- ...Monitoring Location: UMMC Telehealth Job Title RN - Care Coordinator Job Summary To support disease management tasks which include clinical responsibilities... ...experience in clinical nursing with chronic disease, utilization review and/or quality management Knowledge, Skills &...Full timeFor subcontractorCasual workWork at officeRemote workShift work
- ...Medical Center is seeking an Assistant Utilization Coordinator to assist in implementing and investigating the Quality Management, Utilization Review, and Discharge Planning programs. The role... .... Candidates should hold an active NY RN license, with at least three years of...
- CVS Health is seeking a Registered Nurse (RN) for Utilization Management to ensure appropriate care delivery and coordinate patient care with clinical teams. The role emphasizes evidence-based review, care coordination, and collaboration with providers to optimize outcomes...Remote jobFull timeFlexible hoursAfternoon shift
- ...seeking a Registered Nurse Care Coordinator!Ideal candidates will... ...The Care Coordinator RN (CC RN) is responsible... ...the patient's needs, manage the length of stay and promote efficient utilization of resources. Overall,... ...with the utilization review nurse, patient's...Local area
$52 - $56 per hour
...Contract RN For New York Health Plan You've done UM. You'... ...necessity judgment you built in utilization management. 100% remote (U.S.) |... ...intake, investigation, clinical review, decision and notification... ...community-based or long-term care background (not inpatient only...Remote jobContract workAfternoon shift- Highmark Inc. is seeking a full-time REMOTE RN Case Manager to join our utilization management team. The role requires weekend... ...Sat/Sun) plus three weekdays, focusing on review of services, criteria application, and coordination with Health Coaching and case management...Remote jobFull timeWeekend workWeekday work
$35 - $40 per hour
Sagility LLC, a leader in healthcare transformation, seeks an RN Utilization Management Reviewer for a fully remote role. You will perform timely clinical decision reviews for services requiring prior authorization across various clinical areas, applying criteria like...Remote jobHourly pay- A healthcare organization is seeking an experienced Registered Nurse (RN) - Case Management for their New York location. The RN will be responsible for coordinating patient care, managing resources, and ensuring high-quality patient outcomes. Key responsibilities include...
$40 - $45 per hour
Immediate need for a talented RN Care Management Coordinator . This is a 03 months Contract opportunity... ...advanced medical knowledge to cases, utilizing specified resources and guidelines to... ...clarify medical need for services. Review treatment plans/plan of care with provider...Contract workLocal areaImmediate startRemote work- ...national leader in value-based care, we offer senior living... ...alongside care coordinators, analysts, operators, and... ...The primary role of the Utilization Management Nurse is to review and monitor members' utilization... ...years clinical experience as RN, LPN/LVN required....Contract workWork at officeRemote workWeekend work
- Jobot is seeking a BSN-prepared RN with an active New York license and at least... ...years of clinical experience in case management/utilization review for a New York Managed Long Term Care program. This RN Care Manager will coordinate in-home assessments, plan and authorize...Remote jobRelocation package
$26.06 per hour
...CLOSED unrestricted RN license NY... ...Responsible for overall management of member's case within... ...the member's care plan to meet the member... ..., evaluation, coordination and management of... ...effective and efficient utilization of health benefits... ...'s needs, and reviewing and providing...Remote jobHourly payDaily paidContract workTemporary workFor contractorsWork experience placementLocal area1 day per week- ...A healthcare staffing firm is seeking a skilled Utilization Review RN to join their team. This fully remote position requires a valid PA RN license and prior experience in insurance utilization review. Responsibilities include conducting clinical reviews, applying evidence...Remote work
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