Utilization Management Review Nurse
KZX - Astrana Health Management, Inc.
Utilization Review Nurse
Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. This is a remote position for CA-licensed nurses. Candidates must live in California.
We are seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced setting.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
- ...Quality Management PositionParticipates in the development and ongoing... ...QM objectives.Responsibilities:Reviews documentation and evaluates Potential... ...experience as an RNRegistered Nurse in state of residenceMust have prior authorization utilization experienceExperience with...Suggested
$1,980 - $2,120 per week
...Overview Utilization Review RN – Travel Nursing Job in Arcata, California Advance your nursing career as a Utilization Review Registered Nurse (RN)... ...leading healthcare team and play a vital role in utilization management and staff training, all while experiencing the scenic...SuggestedWeekly payPermanent employmentFull timeContract workShift workDay shift- ...Excellus BCBS in New York is seeking a Utilization Management professional to coordinate, integrate, and monitor BH or PH service utilization for members. The role requires RN licensure in NYS, an associates degree, and at least three years of clinical experience. You...Suggested
$29 - $52 per hour
...UnitedHealth Group's Optum unit is seeking a Utilization Review Nurse, RN to perform inpatient utilization management with evidence-based guidelines and medical necessity criteria. The role emphasizes timely review, documentation, and collaboration with physician leadership...SuggestedHourly payRemote workWeekend work- ...Utilization Review Nurse, RNLighthouse Care Center of Augusta is seeking a dedicated, compassionate Utilization Review Nurse, RN to add to our... ..., RN Under the direction of the Director of Utilization Management.Job Duties/Responsibilities:Review clinical content of medical...SuggestedWork at officeLocal area
- ...Utilization Management Review Nurse (UMRN)The Utilization Management Review Nurse (UMRN) performs technical and administrative work required to evaluate the necessity, appropriateness, and efficiency of the utilization of medical services procedures and facilities. This...Work experience placementWork at officeRemote workFlexible hoursWeekend work
- ** UTILIZATION REVIEW NURSE III - WASHINGTON STATE - PRE-SERVICE CLINICAL UR/UM ** ** PRIOR UTILIZATION REVIEW/UTILIZATION MANAGEMENT RN WORK EXPERIENCE HIGHLY PREFERRED! ** ** MUST LIVE IN WASHINGTON OR IDAHO, COMMUTABLE DISTANCE TO KAISER PERMANENTE WASHINGTON MEDICAL...Temporary workWork experience placementLive inLocal area
- ...Utilization Management And Quality Screening PositionResponsible for Utilization Management, Quality... ...standards.• While performing utilization review identifies areas for clinical... ...team.Minimum Qualifications:• Registered nurse with a New York State current license.•...
- ...Utilization Management NurseResponsible for Utilization Management, Quality Screening and Delay Management for... ...Emergency/Trauma Care and/or previous Utilization Review roles.Qualifications and Ideal CharacteristicsRegistered nurse with a New York State current license....
$31 - $38.74 per hour
...operations and after-hours member needs, employees within the Utilization Management (UM) department may be assigned schedules that differ from... ...Under the guidance of the Utilization Management, the UM Nurse Reviewer will leverage expertise to conduct timely reviews of pre-...Hourly payFull timeImmediate startMonday to Friday- ...UnitedHealth Group is seeking a Utilization Review Nurse, RN to perform inpatient utilization management in California. The role involves reviewing inpatient criteria, preauthorizations, and ensuring medical necessity while applying evidence-based guidelines. In addition...Remote workMonday to FridayWeekend work
- ..., Hanover, MD 21076 Category: Nursing Schedule: Day Shift Employment Type... ...Hopkins Health Plans (JHHP) is the managed care and health services business of Johns... ...hours are 8:00 AM - 5:00 PM As a Utilization Review Registered Nurse for Johns Hopkins Health...Full timeLocal areaRemote workWork from homeMonday to FridayDay shift
$1,600 - $1,800 per week
...Now Hiring: Registered Nurse – Utilization Management Location: Buckley AFB & Peterson AFB, Colorado Military Health System Compensation: $1,60... ...consecutive months in Utilization Management, Utilization Review, or Case Management Preferred Certifications: Not required...Contract workImmediate startRemote workMonday to Friday- ...MedStar Health in the DC/Baltimore region seeks a Utilization Management Supervisor to lead the UR team, align daily workflow with physicians, case managers and social workers, and assure high-quality, cost-effective patient care across the department. The role requires...
$40 - $45 per hour
...re a clinically driven RN or LPN with utilization management experience and a passion for making meaningful... ...your expertise in medical necessity review and behavioral health services helps... ...and valid NC or Compact Multistate Nursing License • Experience with...Hourly payTemporary workRemote workMonday to Friday- ...Brighton Health Plan Solutions, LLC is seeking an Utilization Management Nurse to perform medical necessity reviews remotely. Licensed LPN with strong MS Office skills will review clinical criteria, coordinate with care partners, and document determinations in compliance...Remote work
- A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization management, reviewing medical records, and coordinating discharge planning. Candidates must have an active RN license...Contract workRemote work
$88.85k
...Utilization Management Claims Review Nurse RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Salary Range: $88,854.00 (Min.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan...Full time- ...To support a centralized Utilization Management department, the full-time Utilization Review Nurse will conduct timely utilization review activities, ensuring appropriate patient status determinations and compliance with regulatory requirements while working remotely....Full timeRemote work
- ...TriWest Healthcare Alliance seeks a Utilization Management Clinical Review nurse to evaluate and authorize beneficiary care, focusing on cost-effective, appropriate utilization of Behavioral Health and Medical/Surgical services. Responsibilities include preauthorization...Remote work
- ...Utilization Management Registered Nurse Duration: 6 Month Contract (Possibility of Extension) We are seeking an experienced Utilization Management... ...UM) Registered Nurse to support outpatient utilization review and prior authorization activities for a leading...Contract workRemote work
- ...Description Rangam is a global, innovative Total Talent management firm dedicated to accelerating meaningful employment for... ...Role Description This is a Field work contract role for a Utilization Review Nurse. The Utilization Review Nurse will be responsible for...Contract workRemote work
- ...Centene Management Company LLC is hiring for a remote RN/LPN utilization reviewer. You will evaluate patient care, determine appropriate level of care, and contribute to discharge planning while coordinating with Medical Affairs. Role requires 2+ years acute care and UM...Remote workMonday to Friday
- ...who need it most. We offer integrated managed care products, pharmaceutical benefit... ...direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity... ...Experience: ~ Associate's Degree in Nursing (ASN) required; Bachelor's Degree in...Full timeWork at officeRemote workMonday to FridayFlexible hours
$70k - $85k
...We provide comprehensive benefits and managed care services with an emphasis on healthy... ...The primary responsibility of the UM Review Nurse is to conduct prior authorizations and... ...external parties that result in outstanding utilization management of members and their...Temporary workWork at officeLocal area$34 - $47 per hour
...Description Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position... ...seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced setting. Our Values:...Hourly payLive inWork at officeRemote workMonday to FridayShift work- Currently seeking a Utilization Management RN . Please see details and qualifications below: Position... ...Must have an active PA license or a Nurse Licensure Compact to include PA. ** Minimum... ...conditions through medical record review to determine medical necessity for services...Immediate startRemote workDay shift
- WellSense Health Plan is seeking an Inpatient Utilization Management Clinician for a fully remote role in the United States... .... Qualifications include an active RN license, nursing degree, and 2 years of utilization review experience with InterQual. #J-18808-Ljbffr WellSense...Remote job
- ...strategic workforce solutions that help you manage your talent and business more efficiently... ...• Responsible for conducting timely reviews of all requests for services required to... ...review criteria and benefit guidelines • Utilizes clinical information to determine if criteria...
$40 per hour
...Insurance Or Managed Care Industry Registered Nurse (RN) $40/hour - Contract for 6 months Must reside in TX... ...for performing initial, concurrent review activities; discharge care coordination... .... Provides information regarding utilization management requirements and...Full timeContract workWork at officeRemote work
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