Current jobs related to Utilization Review RN - Fredericksburg VA United States - Mary Washington Healthcare
-
Utilization Review RN PRN
4 weeks ago
Fredericksburg, United States Mary Washington Healthcare Full timeStart the day excited to make a difference end the day knowing you did. Come join our team.Job Summary:The Utilization Review Nurse is responsible for following the healthcare system's Utilization Program which integrates the function of utilization review and resource management to assure care is provided in the most appropriate setting utilizing medically...
-
Utilization Review RN
1 month ago
Fredericksburg, United States Mary Washington Healthcare Full timeStart the day excited to make a difference…end the day knowing you did. Come join our team.Job Summary:The Utilization Review Nurse is responsible for following the healthcare system’s Utilization Program which integrates the function of utilization review and resource management to assure care is provided in the most appropriate setting utilizing...
-
RN-Utilization Review
4 weeks ago
Austin, TX, United States Ascension Seton Northwest Full timeRN-Utilization ReviewDetails * Department: UR Review * Schedule: FT - Days * Location: Austin, TX - Remote after 4 weeks of training onsite Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental...
-
Utilization Review RN
2 weeks ago
Austin, TX, United States Ascension Full timeDetails Department: Utilization ReviewSchedule: Full-time, 8-hour day shift, Monday-Friday, Remote, including occasional on-site needs, weekends and holidays requiredFacility: Ascension Care Management InsuranceBenefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term &...
-
Utilization Review RN
2 weeks ago
Everett, WA, United States Providence Full timeDescription Oversee utilization management and review of patients care delivery while in the hospital and provide clinical reviews and denial appeals where appropriate either during admission or post discharge. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Regional Medical Center Everett...
-
Utilization Review RN
1 month ago
Everett, WA, United States Providence Full timeDescription Oversee utilization management and review of patients care delivery while in the hospital and provide clinical reviews and denial appeals where appropriate either during admission or post discharge. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Regional Medical Center Everett...
-
Utilization Review RN
4 weeks ago
Seattle, WA, United States Swedish Health Services Full timeDescription Remote - Utilization Review RN On call/Per diem 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...
-
Utilization Review RN
6 days ago
Seattle, WA, United States Swedish Health Services Full timeDescription Remote - Utilization Review RN On call/Per diem 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...
-
RN-Utilization Review
1 month ago
Austin, TX, United States Ascension Full timeDetails Department: UR ReviewSchedule: FT - DaysLocation: Austin, TX - Remote after 4 weeks of training onsiteBenefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition...
-
Utilization Review Nurse
2 weeks ago
Bremen, IN, United States Neuropsychiatric Hospitals Full timeAbout Us:HEALING THE BODY AND MINDFounded fifteen (15) years ago, NeuroPsychiatric Hospital is the largest hospital system in the nation providing care to patients with both neurological and medical needs. We are unique in that we serve a population which others have been previously been unable to, largely due the patient’s underlying medial issues. Our...
-
Travel Nurse RN
1 week ago
, UT, United States Talent4Health Full timeTalent4Health is seeking a skilled travel nurse RN to fill a Utilization Review position in a dynamic healthcare setting.Job Summary:Job Title: Travel Nurse RN - Utilization Review SpecialistJob Type: Travel NursingSpecialty: Utilization ReviewDiscipline: RNResponsibilities:Conduct thorough reviews of patient care to ensure optimal utilization of healthcare...
-
RN - Utilization Review
6 days ago
Olympia, WA, United States Providence Full timeDescription 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...
-
RN - Utilization Review
16 minutes ago
Olympia, WA, United States Providence Full timeDescription 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...
-
Leesburg, FL, United States UF Health-Central Florida Full timeOverview UF Health Leesburg Hospital has been serving the health care needs of our community for 58 years. The hospital offers advanced cardiac care including one of the largest cardiothoracic surgery programs in the state. The American College of Cardiology has recognized UF Health Leesburg Hospital for its demonstrated expertise and commitment in...
-
Leesburg, FL, United States UF Health-Central Florida Full timeOverview UF Health Leesburg Hospital has been serving the health care needs of our community for 58 years. The hospital offers advanced cardiac care including one of the largest cardiothoracic surgery programs in the state. The American College of Cardiology has recognized UF Health Leesburg Hospital for its demonstrated expertise and commitment in treating...
-
Utilization Review RN IN Behavioral Medicine
2 months ago
Alamogordo, NM, United States Christus Health Full timeDescription Demonstrates knowledge and skills necessary to provide services based on the physical, psychosocial, educational, safety, and other related criteria for appropriate population in his/her assigned area. Maintains required core competencies. Complies with set Policies and Procedures (i. e. name tag, dress code, parking, smoking, etc.) Submits...
-
Utilization Review RN IN Behavioral Medicine
2 months ago
Alamogordo, NM, United States Christus Health Full timeDescription Demonstrates knowledge and skills necessary to provide services based on the physical, psychosocial, educational, safety, and other related criteria for appropriate population in his/her assigned area. Maintains required core competencies. Complies with set Policies and Procedures (i. e. name tag, dress code, parking, smoking, etc.) Submits...
-
LPN for Utilization Review
2 weeks ago
Fontana, CA, United States Pyramid Consulting Full timePyramid Consulting is currently looking for a dedicated Licensed Practical Nurse (LPN) to fill a Utilization Review role on a local contract basis.Position OverviewThe selected candidate will be responsible for:Specialty: Utilization ReviewDiscipline: LPNEmployment Type: Local ContractKey ResponsibilitiesThe LPN will engage in:Coordinating...
-
Utilization Review Coordinator
2 weeks ago
Phoenix, AZ, United States Neuropsychiatric Hospitals Full timeAbout Us:HEALING THE BODY AND MINDFounded fifteen (15) years ago, NeuroPsychiatric Hospital is the largest hospital system in the nation providing care to patients with both neurological and medical needs. We are unique in that we serve a population which others have been previously been unable to, largely due the patient’s underlying medial issues. Our...
-
Nurse Manager Utilization Review
5 days ago
Westwood, NJ, United States Clinical Management Consultants Full timeA leading acute care hospital located in southeastern New York is now searching for an experienced Nurse Manager Utilization Review to join their award-winning healthcare team. This acute care facility was founded over one hundred years ago and today houses nearly 400 licensed beds and offers a wide variety of medical and surgical services. This...
Utilization Review RN
2 months ago
Start the day excited to make a difference…end the day knowing you did. Come join our team.
Job Summary:The Utilization Review Nurse is responsible for following the healthcare system’s Utilization Program which integrates the function of utilization review and resource management to assure care is provided in the most appropriate setting utilizing medically indicated resources. The Utilization Review model outlines a collaborative practice to improve quality through coordination of care impacting length of stay, minimizing cost, and ensuring optimum outcomes. The Utilization Review Nurse is responsible for ensuring services provided are compliant with professional standards, national and local coverage determinations, the Centers for Medicare and Medicaid Services (CMS) as well as state and federal regulatory requirements, as applicable.
Essential Functions and Responsibilities:
- Applies clinical criteria to monitor appropriateness of admissions and continued stay.
- Documents findings and relays information to primary physician as needed.
- Identifies and refers cases to physician advisor per UR policy as appropriate.
- Manages any denials related to information provided to/received from payers.
- Assures that key regulatory requirements are met.
- Documents key updates using appropriate software.
- Collects denial data for outcome and key performance indicators and documents accordingly.
- Identifies appropriate regulatory letters needing to be delivered to patients and families and communicates need to the Unit Care Team.
- Educates physicians and staff regarding appropriate level of care/utilization issues.
- Assures correct documentation of utilization review status within Electronic Health Record Utilization Review Module for timely claim filing.
- Manages and maintains EPIC Work ques related to Utilization Review and timely claim filing.
- Other duties as assigned.
Qualifications
Required:
- Associate’s degree in Nursing
- Two years of experience in acute care hospital setting
- Experience with computer technology, specifically experience with Windows based programs, e-mail, and Microsoft Word.
Preferred:
- Knowledge and experience in utilization review.
License and/or Certifications
Required:
- Valid RN License from Virginia or reciprocal compact state required
Preferred:
- Certification in Case Management
- Certification in MCG Criteria
As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.
