RN Utilization Review Specialist
Health Business Solutions LLC
Health Business Solutions LLC seeks an experienced Utilization Review Nurse in New York to provide clinical guidance, drive appropriate level of care, and support revenue cycle efficiency. You will conduct medical record assessments, coordinate care with interdisciplinary teams, apply utilization criteria, and collaborate with insurers on denials. Requires RN license (US multi-state/compact), BSN preferred, 2+ years UR experience; CCM a plus; strong analytical and communication skills. #J-18808-Ljbffr Health Business Solutions LLC
- ...strong experience in performing chart audits and reviewing medical records, particularly with HEDIS... ...with the ability to communicate effectively and utilize Microsoft Office tools. Educational qualifications may include an RN/LVN with an associate or bachelor degree,...SuggestedWork at office
- ...hospitals to help improve the health of individuals and the quality of life in our community. New Horizons is seeking an Utilization Review Specialist , who will be responsible for following up on patient accounts when authorization for stay is required, initiate pre-...SuggestedLocal area
- TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews, assisting...SuggestedRemote job
- ...A growing healthcare company in New York seeks a Utilization Review Nurse to conduct clinical reviews and ensure medical necessity authorizations are met. The ideal candidate will be an LPN or RN with critical thinking skills and attention to detail, able to manage tasks...Suggested
- Intellectt Inc in New York, Town of Florida, invites applications for a Payor Relations Coordinator II to join the Payor Relations team on a 1-year assignment. This on-site role requires strong administrative skills and experience with payor communications. The position...SuggestedContract work
$27.02 - $48.55 per hour
...About This Role The Utilization Review Clinician - ABA at Centene is responsible for reviewing members' care and health status related to Applied... ...BCBA (Board Certified Behavior Analyst) - required, OR RN (Registered Nurse) - State Licensure and/or Compact State...Hourly payFull timeRemote workFlexible hours- Job Summary We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play... ...appropriate reimbursement. Qualifications Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing...Work experience placement
$26.41 - $51.49 per hour
...Provides support for clinical member services review assessment processes. Responsible for... ...the Molina care model. Adheres to utilization management (UM) policies and procedures.... ...education and experience. Registered Nurse (RN). License must be active and unrestricted...Hourly payWork experience placementWork at officeRemote work- ...guidelines to emergent/urgent and continued stay reviews. Perform onsite review of emergent/... ...member care Educate providers on utilization and medical management processes Provide... ...utilization management as needed Qualifications RN, BSN preferred. 2+ years of clinical...Shift work
- ...RN Specialist - Wound Care at Memorial Healthcare System - Jobs in Hollywood, Florida | SHEAEmployer Log In Post a JobJob SeekersEmployersSign UpMemorial Healthcare SystemJob description Employer profileabout jobs## About Memorial Healthcare SystemBe at the heart of exceptional...Shift work
- ...Rayonier is seeking a detail‑oriented Revenue Specialist to join our team. In this role, you will... ...settlements to verify payment accuracy. Review and prepare delivered tickets to ensure... ...‑key proficiency with proven ability to utilize automated accounting systems and...Weekly payContract workWork at officeWork from homeHome officeFlexible hours
$19 - $24 per hour
...smooth transition process. The Transition Specialist plays a key role in ensuring the seamless... ...Coordinate the transfer, setup, or closure of utilities, vendor contracts, service agreements, and access credentials Collect, review, organize, and archive all property...Hourly payWork at officeTrial periodMonday to Friday$48.6k - $65.96k
The Facilities Support Specialist (Lake Mary, FL) will report to the Manager, Facilities and... ...Inspect facilities and review inspection reports to determine repairs... ...Maintain and update the VMS and SMS systems utilized by Healthfirst. Maintain Healthfirst...Temporary workWork experience placementWork at officeRelocationWeekend work- ...are process-driven, and subject to a high level of control and review. Follows established rules, procedures and global policies. Vendor... ...company policies. Have a willingness and ability to learn and utilize company technology for company required purposes. Organized,...Weekly payPermanent employmentTemporary workWork experience placementWork at office
- ...Senior Specialist, Music Operations This position is on – site in our Royal Caribbean Headquarters Miami 1050 Journey with... ...App offerings to ensure adherence to established SOPs. Utilize data analysis to review guest feedback, trends and comments in Medallia survey to...Full timeWork experience placementSeasonal workWork at office
- ...advocate for the person served when necessary and conducts a regular review of needs for ongoing supports. Provides follow-along support... ...settings and make recommendations for improvement. Ability to utilize positive reinforcement techniques to encourage individuals with...Full timeWork experience placementImmediate startShift work
- ...ENT Associates) Job title: Call Center Specialist Division/Department: Clinic Operations Reports... ...-ups and pending items are completed. Utilize downtime between calls productively to... ...description at any time without notice. Review by: Call Center Manager & Regional...Contract workWork at office
- ...The Health Information Management (HIM) Specialist Sr will work on site on a full-time basis... ...and completion of the quality review process ensures integrity and legality of... ...medical records for physician completion utilizing the Joint Commission standards. Perform...Full timeMonday to FridayDay shift
- ...the opportunity for success. As an ESE Specialist, you will support the school's instructional... ...and school's ESE program. Compile and review comprehensive evaluation data required... ...(ESE), regular education, and parents. Utilize resources from school(s), CSUSA, the district...Work at office
- ...Position Purpose: The Asset Protection Specialist is primarily responsible for preventing... ...their assigned store/multiple stores. They utilize tools to minimize loss to the Company,... ...identifying incidents of theft and fraud, reviewing CCTV and exception reports, monitoring...
- ...Overview The RN Utilization Management plays a critical role in evaluating patient medical records to ensure the necessity and appropriateness... ...Florida license required. 3+ years experience in utilization review or case management. Knowledge of healthcare utilization...
$36 - $41 per hour
SCA Health in New York is seeking a skilled nurse to promote patient safety and comfort in a fast-paced surgical environment. The role includes assessing patients before and after procedures, collaborating with medical teams, and implementing individualized care plans. ...Hourly pay$71.1k - $97.8k
...Become a part of our caring community The Utilization Management Nurse 2 utilizes clinical... ...Qualifications Licensed Registered Nurse (RN) with at least 3 years prior clinical experience... ...experience in utilization management/review and or prior authorizations. Background in...Full timeTemporary workApprenticeshipWork at officeLocal areaRemote workWork from homeHome officeMonday to FridayShift work$17.78 per hour
...properly created, maintained, stored, archived and accounted for Utilize established document control procedures to effectively maintain... ...as DCM electronic records training Participates in peer file review activities Facilitate record requests utilizing established...Hourly payLocal areaLong distance- ...seasons when required. Basic computer proficiency. Comfortable utilizing phones, fax machine, printers, and other general office... .... Any requests to be exempted from these requirements will be reviewed by Datavant Human Resources and determined on a case‑by‑case basis...Work experience placementWork at officeRemote workMonday to Friday
- Duties The Permitting Specialist will assist UI in project identification and provide guidance... ...efforts on large and small-scale utility projects. Assist in coordinating the work... ...assist in scheduling and drafting product reviews). Provide overall support to the project...Temporary workFor subcontractorLocal areaFlexible hours
- ...network application forms, contracts, and associated documents; e. review of network participation and limited participation contracts... ...applications as needed. e. Telecommunications: Ability to utilize or knowledge of call center telecommunications software. f. Licensure...Contract workWork at officeLocal areaRemote workMonday to FridayFlexible hoursWeekend workAfternoon shift
- ...eliminate future fraudulent transactions. Responsible for promptly reviewing all fraudulent transactions, including checks, bill pay,... ...Department to ensure cases and reports are appropriately documented utilizing the Credit Union's AML software. Responsible for completing...Work experience placement
- ...Client Advisors and Account Service Team, as well as with markets. Review insurance policies and contracts and make recommendations for... ...coverage negotiation, and proposal preparation. Proficient in utilizing MS Office, particularly Excel, for data analysis and financial...
$40 per hour
...Nurse Reviewer PT (20‑30 hours week) – Remote Work Environment Non‑Exempt: $40.00 hour... ...guidelines and regulations. The RN will work closely with the Team Lead, Physician... ...medical claims against industry standards, utilizing research of relevant ICD‑10, CPT, and HCPCS...Contract workWork at officeLocal areaImmediate startRemote work
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