Utilization Review Nurse

2 weeks ago


Meadowbrook PA United States Holy Redeemer Health System Full time

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, 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...


  • 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...


  • 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...


  • , MI, United States LanceSoft Inc Full time

    Job Description:This position will be remote role for Nurses in MichiganShould have a valid MI RN LicenseShould Have utilization management experience.Should have experience completing post-acute reviews for the inpatient rehab, skilled nursing facility settings previously.The candidate should be well versed in coordination of care activities along with...


  • Huntsville, TX, United States Huntsville Memorial Hospital Full time

    Under general supervision of the Director of Case Management, the Utilization Review Nurse provides a clinical review of cases using medical necessity criteria to determine the medical appropriateness of inpatient and outpatient services. Provides feedback and assistance to other members of the healthcare team regarding the appropriate use of resources and...


  • Houston, TX, United States CHI Saint Luke's Hospital at the Vintage Full time

    Utilization Review RNOverview Baylor St. Luke's Medical Center is an 881-bed quaternary care academic medical center that is a joint venture between Baylor College of Medicine and CHI St. Luke's Health. Located in the Texas Medical Center, the hospital is the home of the Texas Heart Institute, a cardiovascular research and education institution founded in...


  • Portland, ME, United States Martin's Point Health Care Full time

    Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an...


  • Medford, OR, United States Health Advocates Network Full time

    Health Advocates Network is urgently hiring Utilization Review Registered Nurses (RNs) in the Medford, OR area. Must have 2 years of Discharge Planning and Utilization Review experience. + Pay Rate: $2,760 weekly + Specialty: Utilization Review Registered Nurse (RN) + Shift Info: Day + 13 Week Contracts and more available! RN Qualification and...


  • Randallstown, MD, United States LifeBridge Health Full time

    UTILIZATION REVIEW NURSE (RN)Randallstown, MDNORTHWEST HOSPITALNW CARE MANAGEMENTFull-time - Day shift - 8:00am-4:30pmRN Other81988Posted:March 21, 2024Apply NowSave JobSavedSummaryPosition Summary:Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to...

  • Utilization Reviewer

    2 months ago


    Topeka, KS, United States Pathway Family Services LLC Full time

    Description ****Average hourly rate is $22.60 (including wage, incentives, bonuses, overtime, shift differential, etc.)****      Utilization ReviewerPathway Family Services, LLC. provides resources for youth and families through their Independent Living Program, TRAIL (Teens Reaching Adult Independent Living), Psychiatric Residential Treatment Facility,...


  • Syracuse, NY, United States Nascentia Health Full time

    The Utilization Review Nurse assists the utilization review process taking on various tasks including data collection of demographic, claim and medical information; analysis; and outcomes reporting. Utilizes standards of care, evidence based practices, Medicare and Medicaid and organizational coverage guidelines to assure members receive high quality, cost...


  • Plattsburgh, NY, United States The University of Vermont Health Network Full time

    Please Note: This is an onsite position supporting the Emergency Department at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, NY.GENERAL SUMMARY:The Utilization Review RN monitors, collects and analyzes data and evaluates variances of resource utilization, complications and overall quality of care based on benchmarked criteria or established...


  • Plattsburgh, NY, United States The University of Vermont Health Network Full time

    Please Note: This is an onsite position supporting the Emergency Department at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, NY.GENERAL SUMMARY:The Utilization Review RN monitors, collects and analyzes data and evaluates variances of resource utilization, complications and overall quality of care based on benchmarked criteria or established...


  • Baltimore, MD, United States LifeBridge Health Full time

    UTILIZATION REVIEW NURSE (RN) - PRNBaltimore, MDSINAI HOSPITALUTILIZATION REVIEWPRN - As Needed - 8:00am-4:30pmRN Other82413Posted:March 21, 2024Apply NowSave JobSavedSummaryPosition Summary:Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease...


  • Lubbock, TX, United States Lubbock Heart Hospital Full time

    RN Case Manager/UR ReviewerJOIN OUR TEAM!!! Are you looking to be one of the team? To be part of the family and not just another number? Are you looking for a positive work environment where teamwork and diversity are key? We value your contributions. Every role in our hospital has an impact on each of our patients. We work hard to make sure our employees...


  • Philadelphia, PA, United States Health Partners Plans Full time

    Utilization Management NurseWhy Choose Jefferson Health Plans? We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children's Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone...

  • Travel Nurse RN

    3 days ago


    Baltimore, MD, United States Health Advocates Network-Nursing Full time

    Health Advocates Network-Nursing is seeking a travel nurse RN Utilization Review for a travel nursing job in Baltimore, Maryland.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNStart Date: 06/17/2024Duration: 14 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelHealth Advocates Network is urgently hiring Utilization...

  • Travel Nurse RN

    2 days ago


    Philadelphia, PA, United States Medical Solutions Full time

    Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Philadelphia, Pennsylvania.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeks36 hours per weekShift: 12 hours, daysEmployment Type: Travel We’re seeking talented healthcare professionals whose...

  • Travel Nurse RN

    6 hours ago


    Irving, TX, United States TRS Healthcare Full time

    TRS Healthcare is seeking a travel nurse RN Utilization Review for a travel nursing job in Irving, Texas.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNStart Date: 06/17/2024Duration: 12 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelTRS Healthcare Job ID #1152889. Pay package is based on 8 hour shifts and 40 hours...

  • Travel Nurse RN

    3 days ago


    Hartford, CT, United States Supplemental Health Care Full time

    Supplemental Health Care is seeking a travel nurse RN Utilization Review for a travel nursing job in Hartford, Connecticut.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNStart Date: ASAPDuration: 13 weeksEmployment Type: TravelJob Description:As one of the largest Healthcare jobs placement agencies in the U.S., Supplemental Health...