Coordinates and/or manages medical management review cases identified for utilization management, including review and interpretation of medical records and clinical updates, according to standards used to determine medical necessity, appropriateness...
...maintain and build on positive outcomes. Utilizes clinical expertise, discretion, and independent... ...in Nursing required; BSN preferred RN License in Applicable State of Employment... ...candidates with experience including Utilization Review, ensuring patients are in correct status,...
...completing Behavioral Health medical necessity reviews.
Your career starts now. We’re... ...that treatment delivered is appropriately utilized and meets the Member’s needs in the least... .../ Experience:
Registered Nurse (RN) graduate from an accredited institution...
Would you like to work with a Utilization Management Team whose goal is to provide quality, patient... ...South Houston area.
We are seeking an RN or LVN Case Manager who is highly-... ...with other members of the team to plan and review level of care, length of stay and general...
...Location: Berwyn, PA
Description: The Judge Group is currently seeking a Utilization Review Registered Nurse in the Berwyn, PA area. This position will be in support of a dedicated healthcare professional staff with one of our top hospital...
~3 to 5 years prior acute nursing with critical care experience.
~2 to 4 years managed care/HMO experience in utilization review, case management or discharge planning.
~2 to 3 years management experience in utilization review, case management or...
Occupational Health nurse position*** Must have previous 3-5 yrs OCH, employee Health or Infection control experience,. Active RN license, BLS. Position is Mon- Friday. Shift 8:00 am - 4:30 pm includes a 30 min break Department Infection Prevention
...guidelines and criteria. Ensures appropriate utilization of hospital resources. Works with other... ...1 year of hire. Registration and current RN licensure in the state of MA in good... ...managed care, and other 3rd party payor review requirements desirable. SKILLS/ABILITIES:...
St. Luke's Health System in Boise is seeking an Utilization Reviewer to join our Utilization Review team.
The Utilization Reviewer - RN is responsible for evaluating medical necessity for patient hospitalization and acting as an internal resource for patient...
Care Manager RN for Utilization ReviewLocation: Napa, CASchedule: Full-time - 80 biweekly hoursShift: 8-hour EveningsFUNCTION:The RN Case Manager is responsible for carrying out effective case management functions for identified patients by planning,...
Maria Parham Health
Monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, hospital... ...Certifications:
Basic Life Support (BLS)
Equal opportunity and affirmative action employers and...
...Position Overview : Coordinates utilization of patient care and ensures all personnel... ...Additionally, the UR Supervisor is responsible for reviewing medical records and communicating... ...Level Independently Licensed Clinician/LPN/RN with related experience
...professional clinical staff.
Conduct reviews in accordance with certification requirements... ...and narrative information to report on utilization, non-certified days (including identified... .../SKILL REQUIREMENTS:
Licensed LPN or RN, or Associate's Degree, Bachelor's Degree...
...Department of Correction .
We are currently seeking a Per Diem Utilization Review Nurse to join our Tennessee Regional Office located in... ...can offer both.
Tennessee RN license or ability to obtain license
Utilization Review RN Analyst
Eagleville, PA, US
Reviews admissions to determine medical necessity and appropriateness of treatment.
Secures necessary data for extended stay reviews.
Presents abstract (via telecon) of clinical course of...
...optimal health, access to care and appropriate utilization of resources, balanced with the patientï¿... ...and submission for Physician Advisor review
Securing and documenting authorization... ...Required: Active and valid RN license.
Preferred: Accredited Case Manager...
University of Maryland Medical System Health Plans
The Utilization Review Denial Nurse will support the clinical review operations needed to assist its membership. This position... ...Education, Experience and Qualifications:
· RN or LPN preferred
· Required to have education, training or professional...
...We're looking for experienced clinicians to join our Utilization Management/Clinical Review team . As a Utilization/Clinical Review Nurse, you will... ...qualifications include:
Active, unrestricted RN or LVN (BSN preferred) license
Experience of at least...
...You bring your body, mind, heart and spirit to your work as a Utilization Review Registered Nurse.
Your compassion is tangible: patients feel... ...is to learn.
As a Utilization Review RN you need to know how to:
Use nationally recognized review...