Utilization Management/Quality Review Nurse

About the Job:We are seeking a highly skilled Utilization Review Nurse to join our team at US Tech Solutions. As a key member of our organization, you will be responsible for reviewing documentation and evaluating Potential Quality of Care issues based on clinical policies and benefit determinations. You will work closely with internal/external clinicians to...

Job Description: Participates in the development and ongoing implementation of QM Work Plan activities. Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives Responsibilities: Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies...

About the RoleWe are seeking a highly skilled and experienced Clinical Utilization Management Specialist to join our team at Mindlance. In this role, you will be responsible for ensuring compliance of the Utilization Management (UM) and Quality Review (QR) functions performed by Medical Groups/IPAs participating in the networks of Client's HMOs.The ideal...

Job SummaryThis Clinical Utilization Review Specialist role is a vital part of our team at Integrated Resources, Inc.About the RoleWe are seeking a highly skilled and experienced Registered Nurse to join our team as a Clinical Utilization Review Specialist. In this role, you will play a crucial part in ensuring compliance with utilization management (UM) and...

Your Opportunity:US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. As a Nurse Utilization Reviewer - Clinical Policy, you will be responsible for reviewing documentation and interpreting data obtained from clinical records or systems to apply appropriate clinical criteria and...

Hospitals on Incredible Health are actively hiring and accepting applications in the Chicago, IL area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift, night shift, and mid...

Employment Type: Full timeShift: Day ShiftJob Title: Manager Care Mgt & Util Review Position Highlights: Competitive pay Additional Benefits: Full benefits package starting from day one of employment, Daily Pay, Tuition Reimbursement, Retirement Plans, Supplemental Insurance and more Quality of Life Advancement: Opportunities to advance through the...

Hospitals on Incredible Health are actively hiring and accepting applications in the Chicago, IL area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift, night shift, and...

An exceptional full-service acute care hospital in Southern California is actively interviewing for a Nursing Manager to oversee a complex Utilization Management (UM) and Case Management program. Join this reputable hospital as it leads patient care into the next generation. This state-of-the-art, 350+ bed hospital seeks an experienced full-time Nurse...

Description The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate...

Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused,...

Job DescriptionNote: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs).Work ShiftDayWork Day(s)Monday-Friday, VariableShift Start Time8:00 AMShift End Time4:00 PMWorker Sub-TypePRNChildren’s is one of the nation’s leading children’s...

Job DescriptionNote: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs).Work ShiftDayWork Day(s)Monday-Friday, VariableShift Start Time8:00 AMShift End Time4:00 PMWorker Sub-TypePRNChildren’s is one of the nation’s leading children’s...

Overview: The Utilization Review team is comprised of highly skilled Registered Nurses who ensure Norman Regional Health System follows a compliant review process to determine appropriateness of admission. Responsibilities: * Utilization Review, Utilization Management, Advocacy and Education * Clinical Analysis and Data Management * Clinical Care...

Description: Job Summary Responsible for analyzing medical records for medical-legal reviews. After analyzing provided clinical documentation, Utilization Review Nurses must create a professional executive report that includes a summary, appropriate criteria/guidelines, and a rationale based on evidence-based guidelines. The executive summary will review...

Description Utilization RN Per diem Remote Day shift The Utilization Review (UR) Nurse has a strong clinical background blended with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining...

We are seeking a skilled Registered Nurse with experience in utilization review to join our team at Walker HealthForce. As a local contract nurse RN, you will be responsible for reviewing patient cases and ensuring that medical treatments are necessary and effective.About the JobThis is a 52-week contract position with 40 hours of work per week. The shift...

Manager of Utilization Review/Case Management Silicon Valley near San Jose One of CA's most desirable communities in the heart of Silicon Valley! America's leading nonprofit integrated health plan, my client serves more than 9 million people from 35 hospitals and 431 medical office buildings in nine states and the District of Columbia. Thanks to the...

Employment OpportunityA reputable medical solutions company is looking for a skilled travel nurse RN case manager to fill a temporary position in Lakewood, Colorado.About the JobThis assignment involves providing clinical expertise in utilization review and case management. As a travel nurse RN case manager, you will work closely with the healthcare team to...

Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused,...