Utilization Review Nurse

Found in: Jooble US O C2 - 2 weeks ago


Meadowbrook PA, United States Holy Redeemer Hospital and Medical Center Full time
Utilization Review Nurse

Per Diem 1648 Huntingdon Pike Nursing RN/LPN Day SUMMARY OF JOB: To review each admission for appropriate assignment of level of care based upon clinical guidelines as well as to review documentation for continued stays daily and provide clinical information including assessments and outcomes for all payers and all levels of care as required by the payer. Work with physician advisor to better manage denials and downgrades. CONNECTING TO MISSION: All individuals, within the scope of their position are responsible to perform their job in light of the Mission & Values of the Health System. Regardless of position, every job contributes to the challenge of providing health care. There is an ongoing responsibility for ensuring that the values of Respect, Compassion, Justice, Hospitality, Holistic Approach, Stewardship and Collaboration are present in our interactions with one another and in the services we provide. RECRUITMENT and LICENSURE REQUIREMENTS: Registered Nurse: must have a current license in Pennsylvania from the Commonwealth of Pennsylvania, Department of State Bureau of Professional and Occupational Affairs. Bachelor degree preferred. Experience: Registered Nurse: a minimum of five or more years of acute care clinical nursing. Recent experience in a hospital, insurance company, or independent review company in utilization, quality review, homecare or case management Skills: * Thorough understanding of managed care systems and utilization review criteria * Working knowledge of managed care and third party reimbursement * Experience with case management, evaluation/assessment of clients * One hour of annual stroke education * Basic computer skills required Advocacy and problem solving skills * Excellent time management and strong written and verbal communication skills Possesses strong organizational and negotiation skills * Possesses strong team work skills * Strong organizational and prioritizing skills * Knowledge of community resources * Demonstrated leadership abilities Experience in the use of information systems EOE



  • Meadowbrook, United States Holy Redeemer Hospital and Medical Center Full time

    Utilization Review NursePer Diem 1648 Huntingdon Pike Nursing RN/LPN Day SUMMARY OF JOB: To review each admission for appropriate assignment of level of care based upon clinical guidelines as well as to review documentation for continued stays daily and provide clinical information including assessments and outcomes for all payers and all levels of care...


  • Meadowbrook, United States Holy Redeemer Hospital and Medical Center Full time

    Utilization Review NursePer Diem 1648 Huntingdon Pike Nursing RN/LPN Day SUMMARY OF JOB: To review each admission for appropriate assignment of level of care based upon clinical guidelines as well as to review documentation for continued stays daily and provide clinical information including assessments and outcomes for all payers and all levels of care...


  • Meadowbrook, PA, United States Holy Redeemer Hospital and Medical Center Full time

    Utilization Review NursePer Diem 1648 Huntingdon Pike Nursing RN/LPN Day SUMMARY OF JOB: To review each admission for appropriate assignment of level of care based upon clinical guidelines as well as to review documentation for continued stays daily and provide clinical information including assessments and outcomes for all payers and all levels of care...

  • UTILIZATION REVIEW NURSE

    Found in: Careerbuilder One Red US C2 - 2 days ago


    Meadowbrook, PA 19006, USA, United States Holy Redeemer Health System Full time

    Per Diem1648 Huntingdon PikeNursing RN/LPNDaySUMMARY OF JOB:To review each admission for appropriate assignment of level of care based upon clinical guidelines as well as to review documentation for continued stays daily and provide clinical information including assessments and outcomes for all payers and all levels of care as required by the payer. Work...

  • RN Nursing Graduate

    Found in: Jooble US O C2 - 2 weeks ago


    Philadelphia, PA, United States Temple University Hospital Full time

    PRE-CERTIFICATION RN- 40HR Day Shift (Precertification)- Temple Univ. Hospital Serves as the primary clinical resource in the Pre-certification Department for the handling of complex authorization issues. Ensures precertification/authorization issues are investigated and handled expeditious and thoughtfully from an administrative, technical and clinical...

  • Unit Clerk

    1 week ago


    Meadowbrook, United States Holy Redeemer Health System Full time

    Hosp Medical-Surgical - Full-Time - Day/Evening - 8a-430p Weekend Requirements: None **UNIT CLERK** **Position Summary**: - In direct supervision by the Registered Nurse. Responsible for clerical duties and coordination of indirect patient care on the residential unit. Performs as a resident advocate utilizing effective communications with residents,...

  • Personal Care Aide

    1 week ago


    Meadowbrook, United States Holy Redeemer Health System Full time

    Per Diem 1616 Huntingdon Pike Nursing Service Day/Evening/Night SUMMARY OF JOB: The primary purpose of this position is to assist residents with personal care, daily activities, dietary and housekeeping tasks, and other related functions as assigned by the Care Partner - LPN . CONNECTING TO MISSION: Redeemer Health's ability to Care. Comfort and Heal...

  • Nurse Midwife

    Found in: Jooble US O C2 - 7 days ago


    Philadelphia, PA, United States Holy Redeemer Health System Full time

    Obstetrics and Gynecology Office Nurse ( Ob Gyn RN ) Full-Time 7390 Bustleton Avenue Nursing RN/LPN Day Obstetrics and Gynecology Office Nurse ( Ob Gyn RN ) SUMMARY OF JOB: The PCP office nurse is a Registered Nurse who must be able to perform all aspects of the nursing process under the Professional Nursing Law. He/she functions as a coordinator and...

  • PRE-CERTIFICATION RN- 40HR Day Shift

    Found in: Jooble US O C2 - 2 weeks ago


    Philadelphia, PA, United States Temple University Hospital Full time

    PRE-CERTIFICATION RN- 40HR Day Shift (Precertification)- Temple Univ. Hospital Serves as the primary clinical resource in the Pre-certification Department for the handling of complex authorization issues. Ensures precertification/authorization issues are investigated and handled expeditious and thoughtfully from an administrative, technical and clinical...

  • CORRECTIONS UTILITY PLANT OPERATOR

    Found in: Careerbuilder One Red US C2 - 1 day ago


    , PA, United States Pennsylvania State Government Full time

    Pennsylvania State Government - JobID: 4480924 [Production Operator] As an Utility Plant Operator at the State of Pennsylvania, you'll: Operate the coal-fired boilers and auxiliary equipment to provide steam needed for heat, hot water, and/or processes; Review operation of all Boiler Plant equipment; Operate various Plant equipment such as cranes, dozers,...

  • CORRECTIONS UTILITY PLANT OPERATOR

    Found in: Careerbuilder One Red US C2 - 1 day ago


    , PA, United States Pennsylvania State Government Full time

    Pennsylvania State Government - JobID: 4482156 [Production Operator] As an Utility Plant Operator at the State of Pennsylvania, you'll: Operate the coal-fired boilers and auxiliary equipment to provide steam needed for heat, hot water, and/or processes; Review operation of all Boiler Plant equipment; Operate various Plant equipment such as cranes, dozers,...

  • Consultative Nurse

    Found in: Jooble US O C2 - 1 day ago


    Reading, PA, United States Supportive Concepts for Families Full time

    Consultative Nurse Consultative Nurse Sign on bonus for all Full time positions Today, Conexio Care serves as one of Delawares largest nonprofits, collaborating with government, community, corporate, and other philanthropic partners to maximize services for our states most vulnerable The Program Ambassador is a member of the clinical team who assists...

  • Interim Director of Nursing

    Found in: Jooble US O C2 - 7 days ago


    Gettysburg, PA, United States Genesis Health Full time

    Genesis HealthCare is one of the leading providers of healthcare services from short-term to long-term care and a wide variety of living options and professional clinical services. We are changing how care is delivered by bringing together people like you - passionate, highly skilled and motivated to make a difference. Why Genesis? We improve the lives we...

  • Obstetrics and Gynecology Office Nurse

    Found in: Jooble US O C2 - 7 days ago


    Philadelphia, PA, United States Holy Redeemer Health System Full time

    Obstetrics and Gynecology Office Nurse ( Ob Gyn RN ) Full-Time 7390 Bustleton Avenue Nursing RN/LPN Day Obstetrics and Gynecology Office Nurse ( Ob Gyn RN ) SUMMARY OF JOB: The PCP office nurse is a Registered Nurse who must be able to perform all aspects of the nursing process under the Professional Nursing Law. He/she functions as a coordinator and...

  • Public Health Nurse Home Visitor

    Found in: Jooble US O C2 - 2 weeks ago


    Philadelphia, PA, United States Public Health Management Corporation Full time

    Public Health Nurse Home Visitor (Nurse-Family Partnership) PHMC is proud to be a leader in public health. PHMC requires that all employees are fully vaccinated with the Covid-19 vaccine before the first day of employment. The Public Health Nurse Home Visitor (Nurse-Family Partnership) (NFP NHV) is responsible for providing comprehensive nursing services...

  • UTILITY PLANT OPERATOR 2

    Found in: Careerbuilder One Red US C2 - 1 week ago


    , PA, United States Pennsylvania State Government Full time

    Pennsylvania State Government - JobID: 4436068 [Production Operator] As an Utility Plant Operator at the State of Pennsylvania, you'll: Operate the coal-fired boilers and auxiliary equipment to provide steam needed for heat, hot water, and/or processes; Review operation of all Boiler Plant equipment; Operate various Plant equipment such as cranes, dozers,...

  • Public Health Nurse Home Visitor

    Found in: Jooble US O C2 - 2 weeks ago


    Philadelphia, PA, United States Public Health Management Corporation Full time

    Public Health Nurse Home Visitor (Nurse-Family Partnership) PHMC is proud to be a leader in public health. PHMC requires that all employees are fully vaccinated with the Covid-19 vaccine before the first day of employment. We are looking for compassionate and motivated nurses to work with families towards our shared goals. JOB OVERVIEW: The Public Health...

  • CONSULTATIVE NURSE

    Found in: Careerbuilder One Red US C2 - 1 day ago


    , PA, United States Supportive Concepts for Families Full time

    Consultative NurseSign on bonus for all Full time positionsToday, Conexio Care serves as one of Delawares largest nonprofits, collaborating with government, community, corporate, and other philanthropic partners to maximize services for our states most vulnerable The Program Ambassador is a member of the clinical team who assists clients and guests in...

  • Principal Electrical Engineer-Power

    Found in: Jooble US O C2 - 2 weeks ago


    Philadelphia, PA, United States Burns Full time

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    Found in: Jooble US O C2 - 2 weeks ago


    Philadelphia, PA, United States Good Shepherd Rehab Full time

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