Utilization Review Nurse

Job Description:The Utilization Review Nurse's role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing member treatment records, the utilization review nurse will ensure members do not receive unnecessary procedures, ineffective treatment, or experience...

Job Description: The Utilization Review Nurse's role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing member treatment records, the utilization review nurse will ensure members do not receive unnecessary procedures, ineffective treatment, or experience...

About the RoleWe are seeking a highly skilled and experienced Director of Utilization Review and Operations to join our team at Ridgeview Institute Smyrna. As a key member of our leadership team, you will be responsible for overseeing the Utilization Review Program and ensuring the provision of effective treatment plans for all patients.Key...

Are you a detail-oriented RN with a knack for navigating complex medical cases? Do you thrive on making critical decisions that impact patient care? Join us as a Care Management Coordinator and play a key role in evaluating and authorizing essential healthcare services. Shift: Monday – Friday (8am – 5pm Normal business hours) Type: Temp to...

Are you a detail-oriented RN with a knack for navigating complex medical cases? Do you thrive on making critical decisions that impact patient care? Join us as a Care Management Coordinator and play a key role in evaluating and authorizing essential healthcare services. Shift: Monday – Friday (8am – 5pm Normal business hours) Type: Temp to...

Are you a detail-oriented RN with a knack for navigating complex medical cases? Do you thrive on making critical decisions that impact patient care? Join us as a Care Management Coordinator and play a key role in evaluating and authorizing essential healthcare services. Shift: Monday - Friday (8am - 5pm Normal business hours) Type: Temp to Hire...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.Position Purpose Performs concurrent reviews, including determining member's...

Job DescriptionJob DescriptionDescription:Are you passionate about making a difference? The World Trade Center (WTC) Health Program provides support to those impacted by 9/11. This position for a medical claims review nurse on the World Trade Center (WTC) Health Program will have a direct impact on members of the program. The nurse will be responsible for...

Position OverviewAre you dedicated to enhancing healthcare outcomes? KARNA LLC is seeking a skilled Medical Claims Review Nurse to contribute to our mission of supporting individuals affected by significant health events. This role is pivotal in ensuring that claims are meticulously reviewed for medical necessity and in addressing provider appeals...

Duties include by are not limited to:This is a Pre-Admission Screening position located in the Emergency Department shifts are three 10am-10pm one week, three 10am-10pm and one 10am-6pm the other week, with rotating every third weekend.Promotes effective and efficient utilization of clinical resources. Mobilizes resources as needed to achieve expected goal...

Position Overview: The role of the Healthcare Review Nurse is pivotal in ensuring that medical services are delivered with excellence, cost-effectiveness, and adherence to regulations. By systematically evaluating and auditing patient treatment records, the healthcare review nurse will prevent unnecessary procedures, ineffective treatments, and prolonged...

Position Overview: The role of the Healthcare Review Nurse is pivotal in ensuring that medical services are delivered with excellence, cost-effectiveness, and adherence to regulations. By systematically evaluating and auditing patient treatment records, the healthcare review nurse plays a crucial role in preventing unnecessary procedures, ineffective...

Job DescriptionJob DescriptionPOSITION SUMMARYThe Director of Utilization Review is responsible for overseeing the Utilization Review Program for In Patient and Outpatient services for this for-profit Behavioral Hospital. This includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective...

Position Overview: The role of the Healthcare Review Nurse is pivotal in ensuring that medical services are delivered with optimal quality, cost-effectiveness, and adherence to regulations. By systematically evaluating and auditing patient treatment records, the healthcare review nurse will safeguard against unnecessary procedures, ineffective treatments,...

Description: RESPONSIBLE FOR: The purpose of this position is to ensure that acute hospital admission have the appropriate level of care, patient status, plan of care and meet medical necessity for an acute hospitalization. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role...

Description:RESPONSIBLE FOR: The purpose of this position is to ensure that acute hospital admission have the appropriate level of care, patient status, plan of care and meet medical necessity for an acute hospitalization. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensures...

Description:RESPONSIBLE FOR: The purpose of this position is to ensure that acute hospital admission have the appropriate level of care, patient status, plan of care and meet medical necessity for an acute hospitalization. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensures...

Immediate need for a talented Medical Review Nurse - RN This is a 02+ Months Contract opportunity with long-term potential and is located in North Carolina, NC(Remote) . Please review the job description below and contact me ASAP if you are interested. Job ID:24-40151 Pay Range: $35 - $39/hour. Employee benefits include, but are not limited to, health...

Work schedule: M-F 11:30am-8pm Eastern TimeWork location: This is a virtual position, but candidates must reside within 50 miles of an Elevance Health Pulse Point.The Nurse Medical Management II - Utilization Management is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to...

Clinical Review Nurse I - Medicare Part ANational Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.Location:This is a virtual position and preferred candidates reside within 50 miles...