RN Care Review & Utilization Specialist
Molina Healthcare, Inc.
Molina Healthcare, Inc. is seeking a Nurse Reviewer to support clinical member services review assessment processes in New Mexico. The role ensures medical necessity aligns with clinical guidelines, policies, and regulations while promoting integrated care across the continuum. The ideal candidate will have RN licensure active in NM, plus experience in hospital acute care, inpatient review, or managed care, and strong communication skills to collaborate with multidisciplinary teams. #J-18808-Ljbffr Molina Healthcare, Inc.
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the RN Care Review & Utilization Specialist in Rio Rancho, NM vacancy
$26.41 - $51.49 per hour
...for clinical member services review assessment processes. Responsible... ...integrated delivery of care across the continuum. Contributes... ...Molina care model. • Adheres to utilization management (UM) policies and... ...experience. • Registered Nurse (RN). License must be active and...SuggestedHourly payWork experience placementWork at officeMolina Healthcare
Rio Rancho, NM3 days ago$26.41 - $51.49 per hour
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Fresenius Medical Care
Rio Rancho, NM3 days ago - ...considerations. Department: Care Management Services FTE:... ...Responsible for the initial review, triage and assignment of patients... ...management interventions by utilizing established procedures including... ...with physicians, staff RN‘s, and other health care team...Full timeContract workTemporary workRelocation packageShift workNight shiftWeekend workDay shiftWeekday work
University of New Mexico - Hospitals
Corrales, NM4 days ago $21.17 per hour
...Patient Visit Specialist Presbyterian is seeking a dedicated Patient Visit Specialist to... ...ensuring seamless coordination of patient care while delivering an exceptional experience... ...outlined under HIPAA Responsibilities Review and follow orders entered into the EHR by...Full timeTemporary workWork at officeLocal areaImmediate startMonday to FridayWeekday work- ...RN CASE MANAGER - CARE MANAGEMENT DEPARTMENT - University of New Mexico Hospital - Albuquerque *Inpatient *Outpatient *Utilization Management *SRMC Care Management *Full Time*Part Time Receive 17%... ...treatmentservices. This is supported by a chart review for the level of care and...Full timePart timeReliefWork from homeMonday to FridayShift workNight shiftDay shiftWeekday work
University of New Mexico Hospitals
Rio Rancho, NM3 days ago - ...RN Case ManagerMake a difference. Presbyterian Hospital is hiring an RN Case... ...delivery of effective and efficient patient care. The role integrates utilization management, care coordination, and... ...in nursing plus 5 years utilization review or case management experience...Shift workNight shiftWeekend work
Presbyterian Healthcare Services
Rio Rancho, NM4 days ago - ...Responsible for concurrent review (during the patient... ...during the hospitalization. Utilization of abstracting and data... ...procedures. No patient care assignment.... ..., and certified coding specialist (CCS), identify and record... ...Credentials: Essential: * RN in NM or as allowed by...Full timeRelocation packageShift workNight shiftRotating shiftDay shiftWeekday work
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University of New Mexico - Hospitals
Rio Rancho, NM9 days ago - ...Shift: Days Position Summary: Provide safe, direct patient care utilizing the nursing process in the ambulatory setting. Provide clinical... ...CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days * RN in NM or as allowed by reciprocal agreement by NM Physical...Full timeRelocation packageShift work
University of New Mexico - Hospitals
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University of New Mexico - Hospitals
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United Surgical Partners
Rio Rancho, NM4 days ago - ...policies and procedures. Patient care assignment may include neonate... ...of the educational curricula utilizing adult learning principles to... ...conduct a thorough literature review; demonstrate inclusion of up-to... ...Prof Rescuers w/in 30 days RN in NM or as allowed by...Full timeRelocation packageShift work
University of New Mexico - Hospitals
Rio Rancho, NM4 days ago - ...to assign nurses, technicians and nursing care to assigned patients. Designate shift and... ...-making, crisis intervention, resource utilization, and conflict management * SUPERVISION... ...BLS Prov or Prof Rescuers w/in 30 days * RN in NM or as allowed by reciprocal agreement...Full timeContract workRelocation packageShift workNight shiftWeekend workDay shiftWeekday work
University of New Mexico - Hospitals
Rio Rancho, NM2 days ago - ...decision-making, crisis intervention, resource utilization, and conflict management. Report summary... ...policies and procedures. Patient care assignment may include neonate, pediatric... ...BLS Prov or Prof Rescuers w/in 30 days * RN in NM or as allowed by reciprocal agreement...Full timeContract workWork at officeRelocation packageShift workNight shiftWeekend workDay shiftWeekday work
University of New Mexico - Hospitals
Rio Rancho, NM4 days ago - ...Department: Intermediate Critical Care FTE: 1.00 Full Time Shift: Days... ...research into specialized areas of nursing. Utilize the expertise of a practitioner to... ...as well as the Clinical Nurse Specialist, Specialty RN, or Unit Director to plan and implement...Full timeRelocation packageShift work
University of New Mexico - Hospitals
Corrales, NM4 days ago - ...to assign nurses, technicians and nursing care to assigned patients. Designate shift and... ...-making, crisis intervention, resource utilization, and conflict management * ACCOUNTABILITY... ...Prov or Prof Rescuers w/in 30 days * RN in NM or as allowed by reciprocal agreement...Full timeContract workRelocation packageShift work
University of New Mexico - Hospitals
Rio Rancho, NM4 days ago $136.24k
...s a priority that the company takes good care of you and your family. Our employees... ...equipment costs for these take‐offs. Utilizes Timberline to prepare or assists in preparation... ...for future estimates. Receives, reviews and files pricings received from project...Contract workWork experience placementFor subcontractorH1bCDM Smith
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University of New Mexico - Hospitals
Corrales, NM21 hours ago
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