RN Utilization Review Specialist
MedWatch
MedWatch is seeking a Medical Review Specialist (RN) to conduct utilization review for hospital admissions and procedures. You will verify medical necessity, coordinate with facilities and payers, and document findings in the case record. Ideal candidates have an Associate's degree in nursing (bachelor's preferred), an unrestricted RN license, and at least 5 years of varied clinical nursing experience. Strong organizational, communication, and problem-solving skills are essential. #J-18808-Ljbffr MedWatch
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the RN Utilization Review Specialist in Tallahassee, FL vacancy
- ...Job Summary We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play... ...ensure appropriate reimbursement. Qualifications Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact...SuggestedWork experience placement
- ...Description Daily Responsibilities of Registered Nurse Concurrent Review; Telephonically review inpatient admissions to assure appropriate... ...of Registered Nurse Concurrent Review; Current, active RN in the state of Florida 2+ years of clinical nursing experience Hours...SuggestedPrivate practiceWork at officeMonday to Friday
- ...UF Health in Florida is seeking an experienced RN to support utilization review and case management. You will assess patient records for medical necessity, coordinate with clinicians, and ensure compliant documentation to optimize care and discharge planning. The role...Suggested
$26 - $33 per hour
...skilled nursing facility and custodial admissions and discharges by utilizing the following processes: • The Plan’s daily census • The... ...licensure to practice within the State of Florida • Concurrent review experience - 2 year minimum experience • Managed Care experience...SuggestedPrivate practice$24 - $26 per hour
Utilization Review Specialist - Behavioral Health (Remote) PHP/IOP | Full-Time | Monday-Friday, 9 AM-5 PM ET | $24-$26/hour About the Role Principles Recovery Center (PRC) are hiring a Utilization Review (UR) Specialist to manage insurance authorizations for adolescent...SuggestedRemote jobFull timeMonday to Friday- Principles Recovery Center is seeking a remote Utilization Review Specialist to manage insurance authorizations for adolescent and adult behavioral health, PHP, and IOP programs. The role requires 2+ years of UR experience and fluency with ASAM, LOCUS, and CALOCUS criteria...Remote job
- American Traveler, LLC. is hiring an RN Case Manager for a hospital-based case management team in Florida. The role requires active... ..., and at least two years of recent case management or utilization review experience. The position follows a daytime schedule, 8:00 AM to...
- ...seeking an experienced Registered Nurse in Florida to perform utilization review, review medical records, and consult with care providers to determine... ...based on current research. The ideal candidate holds US RN licensure (or compact state license), a nursing degree, 1+...
- All Jobs > Utilization Review Nurse (Full-Time/ Evening Shift) Full-time Description The Utilization Review Nurse is responsible for conducting... ...Nursing (BSN): preferred Current, unrestricted Registered Nurse (RN) license. Minimum five (5) years of acute care nursing...Full timeWork at officeShift workNight shiftAfternoon shift
- American Traveler is hiring an RN Case Manager for a Case Management department requiring at least 2 years of recent case management... ...Minimum 2 years of recent experience in case management/utilization review required No employment gaps of 90 days or more within the past...Daily paidLocal areaDay shift
- ...of healthcare services in alignment with utilization management guidelines. Collaborates with... ...Education & Experience: Registered Nurse (RN) with a current Florida license required.... ..., or Three (3) years of utilization review, case management, or third-party payer experience...Full timeMonday to Friday
- ...guidelines to emergent/urgent and continued stay reviews. • Perform onsite review of emergent/... ...member care • Educate providers on utilization and medical management processes • Provide... ...as needed Qualifications Qualifications: -RN, BSN preferred. -2+ years of clinical nursing...Private practiceShift work
$31.94 - $43.92 per hour
..., and social workers Lead care planning discussions Utilization Management Review medical necessity & admission status Ensure correct level... ...Case Management (acute care) OR Option 2: 3+ years RN in: Med/Surg Telemetry ICU / PCU ED Neuro...Relocation packageShift workWeekend workAfternoon shift- MedWatch is seeking a Medical Review Coordinator in Florida to perform clinical review duties in line with URAC standards and state requirements... ..., document findings, and coordinate with the Medical Review Specialist and Physician Advisor to ensure accurate and timely...
- ...profile if interested Title: Clinical Care Reviewer Location : Doral, FL Duration : 3 months... ...Skills and Experience: • Current FL RN licensure • Registered Nurse graduated from... ...critical care (e.g. ER, ICU) • Experience with Utilization Review and/or Prior Authorization •...
- Integra is looking for a LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This role collaborates with our Medical Director to perform benefit and medical necessity reviews within...Remote job
- ...expert to oversee well-being, benefits administration and coordination of quality care for subscribers. You will resolve complex utilization management cases, authorize referrals, and ensure medical necessity per criteria while maintaining detailed documentation. The role...
- You will perform frequent case reviews, check medical records and speak with care providers... .... Required Skills Active, unrestricted RN licensure from the United States in [state... ...licenses to meet business needs 1+ year of utilization review experience in a managed care...
- ...enhance lives, and preserve the planet." What do our Innovation/Utility specialists do? The primary purpose of this role is to perform the... ...individuals with disabilities. California residents click here to review your privacy rights. It is unlawful in Massachusetts to...Full timePart timeLocal areaImmediate startMonday to Friday
- ...has named us one of America’s Best Hospitals. What You Will Do in This Role: The Utilization Management Specialist provides advanced operational and workflow support to Utilization Review (UR) Nurses to ensure timely, accurate, and compliant execution of the utilization...Remote job
$71.1k - $97.8k
...Become a part of our caring community The Utilization Management Registered Nurse uses clinical... ...processing time frames. (i.e. 10 reviews per day?) You will communicate with providers... ...: Must hold Compact Registered Nurse (RN) license in your state of residence...Bi-weekly payFull timeTemporary workApprenticeshipWork at officeRemote workHome office- Description The UR Nurse Appeal Specialist is responsible for reviewing payer denials and authoring appeal letters... ...Necessity denials. Using strong utilization review experience and clinical... ...Certifications Registered Nurse (RN) with at least 3 years of acute care...Work experience placementWork at office
- ...remote, but available for onsite meetings) Key Responsibilities Review any new Medicare patients from last 3 months Whether new... ...person will also do the following: Review charts and diagnostics Specialist visits and referrals we've sent Other issues (Smoking, alcohol,...Full timePart timeRemote work
- ...preferred Experience / Qualifications Current RN licensure in the state of Florida BLS... .... Position Summary The Breast Health Specialist nurse is responsible for the physical,... ...performed when circumstances change. I have reviewed these job requirements and verify that I...Local area
- ...Cape Canaveral Hospital Position Summary The CV Invasive Specialist Registered Nurse (RN) delivers direct and indirect patient care in compliance... ...are properly documented for patient charges, accurately utilizing the hospital’s inventory systems. Takes call as rotated/assigned...Full timeWork experience placementRelocation packageShift work
- Registered Nurse (RN) - IV Therapy, Wellness & Longevity Full-Time | Stuart, Florida A Different Kind of Nursing Role iCRYO Stuart... ...document vital signs, health history and required clinical information. Review contraindications, medical clearances, consents and other...Full timeWork at officeFlexible hoursAfternoon shift
- ...or Illinois. We are searching for a new RN to join our team. Our Nurses enjoy the flexibility... ...addition to clinical experience. Please review the roles and responsibilities of this... ..., as applicable, in selecting and utilizing evidence-based criteria and support of clinical...Remote jobHome office
- United Utility Services in Florida is seeking a Safety Specialist to support safe, compliant operations across the organization, conducting field observations, leading safety discussions, and reinforcing policy compliance among distribution line crews. You will serve as...
- Enterprise Engineering Inc. (EEI) seeks a healthcare data reviewer to support Medicare patient reviews and KPI reporting. The role starts part-time (20 hours per week) with potential to move to a full-time opportunity, and involves on-site meetings in Central Florida along...Full timePart timeRemote work
- Suwannee Room - General Utility Worker - Florida State University Why Us Getting Hired Life at Aramark Aramark.com Language Employee Login Apply now Job Description Title: Suwannee Room - General Utility Worker - Florida State University Requisition #: 683158 Location:...Flexible hoursAfternoon shift
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to RN Utilization Review Specialist. Be the first to apply!
Related searches
- public health registered nurse Tallahassee, FL
- temporary rn Tallahassee, FL
- cath-lab rn Tallahassee, FL
- perioperative rn Tallahassee, FL
- part time rn Tallahassee, FL
- pacu rn Tallahassee, FL
- travel registered nurse l&d Tallahassee, FL
- nicu registered nurse Tallahassee, FL
- telephonic rn Tallahassee, FL
- rn urgent care Tallahassee, FL


