Utilization Review RN: Care Coordination & Compliance
Pchospital
Perry County Memorial Hospital in Tell City, IN is seeking a licensed Registered Nurse to join our clinical team. Requirements include graduation from an accredited school of nursing, Indiana RN licensure with current BLS, and at least two years of hospital clinical experience. Preferred: utilization review, case management, discharge planning, DRGs, or CMS Swing Bed experience. We offer a collaborative environment, ongoing professional development, and competitive benefits. #J-18808-Ljbffr Pchospital
- MarinHealth is seeking a Utilization Review Nurse II to perform admission, concurrent and retrospective... ...a BSN preferred, 3+ years of acute care experience, and experience with case... ...role you will assess clinical stability, coordinate transfers for continued care, and...Suggested
- ...Blue is seeking a Supervisor, Utilization Review to lead the daily... ...in the UK. The role ensures compliance with payer guidelines and regulatory... .... Responsibilities include coordinating with physicians, payers,... ...teams to optimize patient care and reimbursement, delivering...Suggested
- ...Hospital in Buffalo, NY seeks a Registered Nurse, Utilization Review, to join the middle revenue cycle and interdisciplinary care team, delivering comprehensive UR in the... ...party payer relationships and inquiries. BSN or RN with a BS, NYS RN license, CCM certification within...Suggested
- L.A. Care Health Plan in Los Angeles, CA is seeking a Utilization Management (UM) Claims Review Nurse RN II to evaluate medical claims for medical necessity, documentation, and proper... ...and retrospective reviews and ensures compliance with state, federal, and accreditation...Suggested
$110k
...Nyack, New York Department: Care Management Work Shift: Day Work... ...are met and care delivery is coordinated across the continuum.... ...and with the most efficient utilization of resources. Carries out activities... ...documentation for justification. Reviews the patient’s plan of care in...SuggestedDaily paidFull timePart timeFlexible hoursShift work- INTEGRIS Baptist Medical Center in Oklahoma City, OK is seeking a day shift/variable, full-time RN Case Manager - Utilization Review. You will assess patients, coordinate transfers, and develop discharge plans to optimize resources and patient outcomes. Qualifications...Full timeDay shift
- ...other highly skilled health care professionals—UofL Health... ...Position Summary and Purpose The Utilization Review RN performs activities which... ...appropriate level of care; coordinates care in conjunction with... ...with OIG Workplan Audits and compliance issues; reports problems...Work at officeShift work
- ...Registered Nurse to join the Primary Care Team in Worcester, MA. This full-time position coordinates home health, quality improvement, and utilization review for center patients, ensuring timely... ...documentation. The role requires MA RN licensure and a Bachelor’s degree in...Full time
- ...case management team with a strong focus on utilization review, ensuring compliant care and reducing unnecessary hospital stays.... ...collaborates across departments to optimize care coordination and outcomes. Requirements include RN license with BSN, UR/UR-related credentials...
$77.08k - $119.47k
## Utilization Review NurseApplylocations: 43 New Scotland Avenue Albany, NY 12208time type: Full... ...Todayjob requisition id: 71163Department/Unit:Care Management/Social WorkWork Shift:Day (... ...to Medical Director and Triad Team in compliance with Department procedures and follows...Shift work- ...our team as a day shift/variable, full time, RN Case Manager - Utilization Review, at INTEGRIS Baptist Medical Center,... ...utilizing all available resources. Recommends and coordinates timely transfers to appropriate levels of care as indicated by clinical needs and...Full timeWork at officeDay shift
- ...clinically orientated medical chart reviews and other administrative tasks... ...of the medical center's utilization review plan, state and federal... ...; three (3) years of clinical care or nursing experience; OR an equivalent... ...OUR TEAM!! Utilization Review RN - Per Diem* *IMPORTANT NOTE:...Hourly payDaily paidWork experience placement
- ...seeking an experienced Registered Nurse (RN) - Utilization Review to evaluate the medical necessity, appropriateness, and level of care for patients. The RN will review clinical... ...reconsiderations when applicable. Ensure compliance with applicable healthcare regulations,...
$66.83k - $111.38k
...Wyoming. Job Responsibilities Utilization Review Nurse is responsible for... ...certification, continued stay review, care coordination, or discharge planning for... ...setting reviews to ensure compliance with applicable criteria,... ...: Registered Nurse (RN) License (Compact or Virginia...Permanent employmentFull timeTemporary workRemote workShift workDay shift- ...Health Plans Community Care is looking to hire a Utilization Review Nurse. The Utilization Review... ...pre-certification, care coordination for appropriateness of... ..., set reviews to ensure compliance with applicable criteria... ...Review Nurse, RN, Care Coordination, or Discharge...Temporary workRemote workShift work
- Optum is seeking a Utilization Review Nurse (RN) to perform inpatient utilization management, applying evidence-based guidelines to determine medical... ...role requires strong clinical judgment, documentation in care management systems, and collaboration with physician leadership...Remote workWeekend work
- ...Group is seeking a qualified Utilization Management Nurse to review patient records and craft... ...letters, ensuring accuracy and compliance. You will support OPAS and... ...reviews. Requirements include an RN license, 3+ years bedside nursing in acute care, and proficiency with...Remote jobWork at officeFlexible hours
$60.2k - $107.4k
Optum is a global healthcare organization empowering care through technology. The Utilization Management Nurse role involves reviewing medical records, extracting case details, and crafting defensible appeal letters according to process instructions and guidelines. The...Remote jobFull timeMonday to Friday$77.02k - $117.58k
...Bay Times’ Top Workplaces. Summary The Utilization Review Nurse is responsible for performing initial... ...medical necessity, appropriate level of care, and continued stay in accordance with... ...Yes Minimum Licensure: Registered Nurse (RN) Minimum Licensure (Other): Knowledge of...Full timeWork at office$88.85k
...(Max.) Established in 1997, L.A. Care Health Plan is an independent public... ...that purpose. Job Summary The Utilization Management (UM) Claims Review Nurse RN II is responsible for conducting... ...ensure accurate adjudication and compliance. This position collaborates closely...Full time- Hilo Benioff Medical Center is seeking an experienced Registered Nurse IV to join our Utilization Review team. This role ensures medical necessity and appropriate level of care while supporting reimbursement through clinical reviews. The ideal candidate brings strong clinical...
- Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective... ...issues and participates in coordination of individualized patient care services. The Utilization Reviewer... ...Registration/Licensure: Current US state RN license with authorization to...Work at officeShift work
- ...seeks an experienced Registered Nurse for Utilization Review to perform quality reviews, prior... ...The role collaborates with physicians and care teams to ensure compliant, timely patient... ...payors. The position requires an Alabama RN license, with a Bachelor's degree in Nursing...
$30 - $35 per hour
...Nursing Care Coordinator (RN / LPN)Brooklyn, NYNursing Care Coordinator (RN /... ...administrative role, you will review and verify chart documentation to ensure compliance and support seamless continuity... ...management verticals.Systems Utilization: Maintain proficiency across...Full timeWork at officeMonday to Friday- Comagine Health in Alabama is seeking Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective utilization reviews. This is a full-time remote role supporting Alabama contracts. You will...Remote jobFull time
- Comagine Health seeks Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time, remote position requires Alabama licensure and focuses on compliant, cost-effective...Remote jobFull timeContract work
- ...ensuring top-tier patient care? Avante at Melbourne... ...is seeking an MDS Coordinator to oversee and coordinate... ...assessments, ensuring compliance with federal, state, and... ...appropriate assessment review dates. Evaluate and update... ...Licensed Nurse (LPN/RN) in the state. Nursing...Local areaRelocation package
- ...efficient, cost effective care management process by determining... ...healthcare continuum and compliance with program/Parkland... ...and skill set related to utilization review, care coordination, performance improvement and... ...Must have current, valid RN license or temporary RN...Temporary workReliefMonday to FridayShift workWeekday work
- ...RN - Utilization ReviewNumber of Positions: 1Remaining Positions: 1Duties: 1 year of non-acute utilization review experience - required RN experience - preferred This is the pay range that RightSourcing (a part of Magnit) reasonably expects to pay someone for this position...
$55 - $65 per hour
...Registered Nurse With Utilization Review ExperienceA healthcare organization is seeking a Registered... ...and requires an active New York State RN license. The ideal candidate will have... ...of review activities.Support compliance with organizational, regulatory, and payer...Hourly payContract work
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