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- Overview Come lead with us at Houston Methodist Hospital. At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and...SuggestedPermanent employmentWork experience placementReliefLocal area
$35 - $45.94 per hour
Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team. Oscar is the first health insurance company built... ...regulations Other duties as assigned Requirements: Active, unrestricted RN licensure from the United States in [state], OR, active...SuggestedHourly payFull timeRemote workWork from homeHome office- Title - Clinical Review Nurse - Concurrent Review Duration - 6 months Location - Remote TX... ...health management systems according to utilization management policies and guidelines Works... ...experience- 4 years is preferred Required: Texas RN Preferred Years of experience required:...SuggestedRemote workWork from home
- A leading health insurance provider is hiring a Utilization Review Nurse to perform case reviews and make care recommendations. Responsibilities... ...applying clinical guidelines. Candidates must have an active RN license, a nursing degree, and at least one year of utilization...SuggestedRemote job
- ...healthcare organization in Wisconsin is looking for a Utilization Management Clinical Registered Nurse responsible for providing precertification and telephonic reviews of inpatient hospitalizations. Candidates must hold an RN license and have at least three years of nursing...Suggested
$41 - $45.5 per hour
...License Required: Active, unrestricted RN License Must have MCG/InterQual experience... ...clinical assessments, health education, and utilization management. Key Responsibilities:... ...prospective, concurrent, and retrospective reviews for inpatient, rehab, referrals, and select...SuggestedRemote job- A leading healthcare provider in the United States is seeking an experienced Utilization Review Nurse (URN) PRN to conduct thorough medical record reviews to determine the necessity of inpatient services. The ideal candidate must be a Registered Nurse with a minimum of...SuggestedRelief
$29.05 - $67.97 per hour
...provider is seeking a skilled individual for a clinical review role involving medical claims and internal... ...nursing experience, including a strong background in utilization review and coding. Candidates must hold an active RN license and possess excellent analytic and...SuggestedHourly pay- ...the either of the five business plans: IL, TX, NM, MT or OK or TN RN working in the insurance or managed care industry using medically... ...is responsible for performing accurate and timely medical review of claims suspended for medical necessity, contract interpretation...SuggestedFull timeContract workRemote work
$29.05 - $56.64 per hour
...support for medical claim and internal appeals review activities - ensuring alignment with... ...Resolves escalated complaints regarding utilization management and long-term services and supports... ...and experience. + Registered Nurse (RN). License must be active and unrestricted...SuggestedHourly payWork experience placementWork at officeMolina Healthcare
La Crosse, WI5 days ago- A leading healthcare provider is looking for a Utilization Review Nurse (URN) PRN in Wisconsin. This role requires a licensed RN to conduct medical record reviews for medical necessity and level of care, collaborating with case management to ensure optimal patient care....SuggestedRelief
$27.02 - $48.55 per hour
Join to apply for the Clinical Review Clinician - Appeals role at Centene Corporation .... ...fresh perspective on workplace flexibility. RN Strongly Preferred - Compact RN License... ...Medicaid regulations preferred. Knowledge of utilization management processes preferred. License...SuggestedHourly payFull timePart timeWork at officeRemote workFlexible hoursShift work$29.05 - $67.97 per hour
...healthcare provider is looking for a Clinical Reviewer in Madison, WI. This role involves... ...member care. Candidates must have an active RN license and at least 2 years of clinical nursing experience, including utilization review. The pay range is competitive, from...SuggestedHourly pay$29.05 - $67.97 per hour
...support for medical claim and internal appeals review activities - ensuring alignment with... ...Resolves escalated complaints regarding utilization management and long-term services and supports... ...and experience. Registered Nurse (RN). License must be active and unrestricted...SuggestedHourly payWork experience placementWork at officeRemote workMolina Healthcare
La Crosse, WI5 days ago- Overview Job Description We’re searching for a Utilization Management Clinical Registered Nurse,... ...performing telephonic and/or concurrent review of inpatient hospitalizations and... ...purposes of obtaining and maintaining an RN license required or Bachelor's degree in...SuggestedLocal area
- Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are currently... ...and Workers’ Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-clinical role offering...Price workExtra incomeFor contractorsRemote workFlexible hours
$29.05 - $67.97 per hour
...Team! We are looking for a dedicated Nurse Reviewer to become an integral part of our... ...and resolve escalated concerns related to utilization management and long-term services, prioritizing... ...Active, unrestricted Registered Nurse (RN) license. Proficient in ICD-10, CPT...Hourly payWork at officeMolina Healthcare
Madison, WI2 days ago- ...group of patients across the age continuum. The Registered Nurse utilizes the nursing process of assessment, planning, implementation and... ...to determine plan of care and to create a discharge plan • Reviews and updates plan of care minimally every 24 hours Implementation...Part timeLocal areaRelocation packageNight shiftWeekend work
OakLeaf Surgical Hospital
Altoona, WI9 hours ago - A health care provider in Madison seeks a Registered Nurse to oversee medical claim reviews and ensure compliance with regulations. You will facilitate reviews, validate claims, and ensure quality of care while working closely with various stakeholders. The ideal candidate...Hourly pay
- A healthcare management company is looking for a Clinical Review Nurse to work remotely. This role involves performing concurrent reviews of members' health and medical necessity, collaborating with providers, and ensuring quality care. Candidates should have a bachelor...Remote jobCasual work
$34 - $51 per hour
...technical software setting and process/utilization improvement. Improves clinical patient care... ...and writing reports. Participates in reviewing results of clinical performance assessments... ...’ experience as a registered nurse (RN) in a clinical role preferred. Thorough...Full timePart timeWork experience placementWork from homeShift workSanford Health
Lyons, WI2 days ago- A healthcare company is seeking an RN Coordinator for Utilization Management. This remote role requires review of authorization requests and collaboration with various departments. Candidates should have a current RN license in Wisconsin, an Associate Degree in Nursing,...Remote jobWeekend work
- The RN Coordinator Utilization Management reviews submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization...Work at officeLocal areaWork from homeHome officeMonday to Friday
- ...Manager/Clinical Coordinator. The Registered Nurse (Rn) Assesses, Plans, Implements, Evaluates And... ...For Customer Service, Teamwork, Resource Utilization, And Staff And Self Development As Outlined In Performance Review. # Performs Other Duties As Assigned Or Directed...
Yale New Haven Health
Darien, WI5 days ago $29.05 - $67.97 per hour
A leading healthcare organization seeks an experienced Registered Nurse to support clinical and medical claims reviews, ensuring compliance with regulatory requirements. The ideal candidate will have at least 2 years of clinical nursing experience and proficiency in coding...Hourly pay$83.2k - $128.96k
...and the supervision of the Nurse Manager (RN) and/or Nurse Supervisor (RN), the RN may... ...documents results in EHR • Performs review and triage of incoming test results, patient... ...as necessary • Facilitates the utilization of resources to meet patient outcomes and...Full timeWork at officeShift workAlbany Medical Center
Hudson, WI1 day ago- ...Staff/Medical - Surgical Registered Nurse (RN) is to provide, direct, and supervise the... ...that are not REAL ID compliant cannot be utilized as an acceptable form of identification... ...windowLearn more about federal benefits. Review our benefits Eligibility for benefits...Permanent employmentFull timeTemporary workPart timeSeasonal workImmediate startRemote workRelocation packageNight shiftWeekend work
VETERANS HEALTH ADMINISTRATION
Milwaukee, WI3 days ago - 1 month ago Be among the first 25 applicants Description Dane Street, a leading Independent Review Organization (IRO) and national provider of Utilization Review (UR) services, is currently expanding our physician panel. We are seeking Board-Certified Orthopedic Surgeons...Extra incomeContract workFor contractorsRemote workFlexible hours
$26.41 - $51.49 per hour
...SummaryProvides 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 office- Your Role The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced... ...CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) required Advanced...Contract work
