RN Utilization Review Specialist - Care Management
Phoebe Putney Memorial Hospital, Inc.
Phoebe Putney Memorial Hospital, Inc. in Georgia is seeking a Registered Nurse UR Specialist. Key responsibilities include managing insurance notifications, obtaining necessary certifications and authorizations, and liaising with third-party payers. The ideal candidate will have a minimum of 4-5 years in acute care and 1-2 years in utilization review. This position requires a Georgia RN license and a commitment to effective patient advocacy. Strong interpersonal communication and organizational skills are essential to succeed in this fast-paced environment. #J-18808-Ljbffr Phoebe Putney Memorial Hospital, Inc.
- Capital Health is seeking a Clinical Denials Utilization Review RN in New Jersey to manage utilization reviews related to inpatient care. The role involves overseeing denial and appeal processes, ensuring compliance with CMS guidelines, and requires a minimum of five years...Suggested
- ...Director of Utilization Review Under the direction of the Director of Utilization Review, the Specialist will coordinate Medicaid Managed Care authorizations and re-authorizations for clients receiving behavioral healthcare services from Odyssey House's Part 820 residential...SuggestedTemporary workFlexible hours
- ## Clinical Denials Utilization Review RN - FT - Day - Utilization Resource Management Pennington NJApplylocations: RMCtime type: Full timeposted on: Posted Todayjob... ...leader in providing progressive, quality patient care with significant investments in our exceptional physicians...SuggestedFull timeTemporary workPart timeFlexible hours
$23.01 - $34.24 per hour
...Position responsibilities will include utilization management support functions for patient admissions... ...of need for initial and continued stay reviews, and process continued stay and... ...dedication to delivering outstanding patient care. When you join us, you become part of Mount...SuggestedHourly payFull timeTraineeshipWork at officeLocal areaShift work$50k
Employer Industry: Behavioral Healthcare Management Why consider this job opportunity... ...pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the... ...Excellent communication skills with managed care companies Proactive problem-solving...SuggestedRemote job- Currently seeking a Utilization Management RN . Please see details and qualifications below: Position is remote - candidate must... ...services. You’ll use advanced clinical judgment to review medical records, validate care plans, and authorize services that meet established...Immediate startRemote workWeekend workDay shift
- ...New Jersey is seeking a Quality Management Nurse to oversee patient care quality. This role involves reviewing patient records for treatment appropriateness... ...degree in Nursing, a New Jersey RN license, and experience in clinical nursing or utilization review. The position offers...
- ## Capacity Management Specialist RNApplyremote type: Remotelocations: Remote... ...submitting an application, please review these frequently asked... ...Capacity Management Specialist RN## Department:University... ...collaborates with other patient care departments/areas that impact...Remote workShift work
- ...patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the... ...on medical necessity. This position manages medical necessity process for accurate... ...work delegated to Central Utilization Review LVN/LPN Case Manager and/or Central...Work at officeRemote work
- Job Description We are seeking an experienced Utilization Review Nurse to join our team in a hybrid role based... ...compliance standards. Participate in case management and care coordination meetings. Qualifications Active RN license in the state of New York. Minimum of...Work at officeRemote workMonday to FridayFlexible hours
$26.41 - $61.79 per hour
...for clinical member services review assessment processes. Responsible... ...integrated delivery of care across the continuum. Contributes... ...care model. Adheres to utilization management (UM) policies and procedures.... ...experience. Registered Nurse (RN). License must be active and...Hourly payWork experience placementLive inWork at office- ...progressive, quality patient care with significant investments... ...Position Overview*** Performs chart review of identified patients to... ...to conduct continued stay utilization review activities with payers... ...medical staff, care team and case managers as necessary to resolve...Full timeTemporary workPart timeWork at officeLocal areaImmediate startFlexible hoursNight shift
$70k - $100k
Utilization Management RN - Behavioral Health (OR Licensed) Position Responsibilities Specific Determine... ...(MCG, InterQual, etc.) Perform 15-30 reviews per day Performs initial and... ...focus on the core principles of managed care: Patient Education, Wellness and Prevention...Minimum wageWork at officeMonday to Friday- A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote jobFlexible hoursWeekend workDay shift
- CVS Health is looking for a highly skilled Utilization Management Nurse (RN) for a remote position. In this role, you will ensure patients receive appropriate healthcare services through reviews of clinical cases and collaboration with providers. The ideal candidate will...Remote job
- ...Health in New Jersey is seeking a Utilization Management Registered Nurse (UM RN) responsible for evaluating the appropriateness... ...services to ensure optimal patient care delivery. The ideal candidate will... ...with 3+ years of Utilization Review or Case Management experience. We...
$101.5k - $126.88k
...Category: Management - Clinical Agency... ...Medicare and Medicaid managed care health plans, are outstanding... ...staff FREE Online RN to BSN and MSN degree... ...physician, PCP, utilization managers, social workers... ...performance appraisals, salary reviews and staffing....Full timePart timeWork at officeRelocation packageFlexible hours$72.47k - $108.71k
Overview 3034037: Licensed Wellness Self Management Specialist -Psych Admin - Rivington - Full Time... ...Provides linkage and liaison with primary care provider. Provides health evaluation... ...Identifies learning strengths and needs. Utilizes learning resources. Communication/...Full timeTraineeshipLocal area$26.01 - $68.55 per hour
...a Medicare Precertification Utilization Management Nurse Consultant to work remotely... ...The role requires an active RN license and a minimum of 3... .... Responsibilities include reviewing clinical information, making... ...with providers for quality care. This full-time position...Remote jobHourly payFull time$45k - $70k
A healthcare management firm is seeking a Utilization Management Nurse Reviewer to ensure efficient use of medical services. The role involves reviewing medical records, assessing treatment necessity, and collaborating with healthcare providers. Candidates should possess...Remote job- ...and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples... ...including treating physician, PCP, utilization managers, social workers, and discharge... ...selection, performance appraisals, salary reviews, and staffing. Qualifications Bachelor...
- Appworkshub is seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this... ...conduct inpatient and outpatient utilization reviews, support transitions of care, and ensure compliance with Medicare Advantage...Remote job
- Village Center for Care, Inc. is seeking a Supervisor of Utilization Management in New York. The role involves overseeing concurrent reviews and discharge planning for members in inpatient and skilled... ...must hold a valid New York State RN license, have 2 years of utilization...
- 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...
- ...orientation period and at the manager's discretion. Includes... ...for licensure as an RN in the Commonwealth of... ...Interqual Level of Care Criteria, MCG, or available... ...and admission review for Medicare and Medicaid... ...regarding appropriate utilization of resources. Promotes...Full timeWork experience placementWork at officeLocal areaImmediate startNight shift
$85.7k - $128.54k
## Utilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License)Applyremote type: Fully Remotelocations: Anywhere... ...mold in conventional health care, committed to serving... ...Nurse Lead is responsible for reviewing requests for inpatient and prior...Remote jobImmediate startMonday to Friday- ...York is seeking a Clinical Utilization Specialist to oversee the authorization... ...Associate's Degree and LPN or RN certification, along with at... .... Responsibilities include reviewing health services for medical... ...necessity and collaborating with care teams to ensure quality care...
- ...how we support, serve, and care for our people. The HRIS Specialist - Dayforce plays a... ...Reporting to the Senior Manager, People Operations, this... .... Support data security reviews and access audits across... ...demographics, engagement, time‑off utilization, and budgeting. Support...Full timeContract workFor contractorsFor subcontractorWork at officeImmediate start
- Job Summary The primary responsibilities of the RN UR Specialist include performing activities related to insurance company... ...certifications and authorizations related to Utilization Review duties in Care Management. Timely communication of clinical information and updates...Remote jobContract workWork at officeShift work
- ...providing person-centered care across behavioral... ...Behavior Intervention Specialist will perform all necessary... ..., Departmental, Case Reviews, Special IDT, Consult... ...regulations. # Utilize data to monitor the effectiveness... ...behaviors, anger management, coping skills,...Hourly payFlexible hours
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