Utilization Review Nurse

POSITION SUMMARY: The Utilization Review Specialist is responsible for assisting in the facilitation of critical criteria reviews on patients for behavioral medicine admissions and continued stays, completion of certifications/interfaces with managed care organizations, external reviewers and other payers. JOB DETAILS: Full time day shift PRINCIPAL DUTIES...

POSITION SUMMARY: The Utilization Review Nurse ensures the delivery of cost-effective quality care within an appropriate length of stay.JOB SPECIFIC RESPONSIBILITIES:General Responsibilities:•Maintains PHI and HIPAA for each patient in accordance with hospital policy and federal regulations.•Promotes safety in the workplace and a safe patient environment...

Job Summary:The Utilization Review Specialist is a key member of our healthcare team, responsible for ensuring the medical necessity of patient admissions and continued stays. This role requires a strong clinical background, excellent communication skills, and the ability to work collaboratively with physicians and other healthcare professionals.Key...

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. ****NOTE: This is a fully remote role. Preference will be given to applicants...

Title: Clinical Review Nurse - Prior Authorization Duration: 03 Months (Contract to Hire) Location: Remote - Nationally Sourced Shift: Monday - Friday. (Can be EST (highly preferred), CST (second preference). (We can negotiate schedules. If someone is willing to work weekends that would be in the future. On the weekends we have a skeleton crew and generally...

Location: Remote - sourced nationally. SHIFT: Monday - Friday (8 hours) In the beginning they will not have a set weekend commitment. Once the new hire is fully trained, they are going to have to work (8) hours per day Monday - Friday. (Can be EST (highly preferred), CST (second preference). ( Client will negotiate schedules. If someone is willing to work...

Location: Remote sourced nationally. SHIFT: Monday Friday (8 hours) In the beginning they will not have a set weekend commitment. Once the new hire is fully trained, they are going to have to work (8) hours per day Monday Friday. (Can be EST (highly preferred), CST (second preference). (Client will negotiate schedules. If someone is...

Description Introduction Are you looking for a work environment where diversity and inclusion thrive? Submit your application for our RN Clinical Reviewer opening with HCA Houston Healthcare Northwest today and find out what it truly means to be a part of the HCA Healthcare team. Benefits HCA Houston Healthcare Northwest, offers a total rewards package...

System One is seeking a Utilities Engineer for a direct hire role in Houston Tx. The Utilities Engineer will monitor condition, ensure optimal & efficient performance, guide investment priority, lead change, implement enhancements and be responsible for the overall operational excellence of all plant related utilities for Monument Chemical. The Utilities...

Description IntroductionAre you looking for a work environment where diversity and inclusion thrive? Submit your application for our RN Clinical Reviewer opening with HCA Houston Healthcare Northwest today and find out what it truly means to be a part of the HCA Healthcare team.BenefitsHCA Houston Healthcare Northwest, offers a total rewards package that...

Description IntroductionAre you looking for a work environment where diversity and inclusion thrive? Submit your application for our RN Clinical Reviewer opening with HCA Houston Healthcare Northwest today and find out what it truly means to be a part of the HCA Healthcare team.BenefitsHCA Houston Healthcare Northwest, offers a total rewards package that...

BGE, Inc. is a nationwide engineering consulting firm that provides services in civil engineering, planning, landscape architecture, construction management, survey and environmental services for public and private clients. Our employees enjoy a comprehensive benefits package to include outstanding health care, generous 401(k) match, career mapping and...

BGE, Inc. is a nationwide engineering consulting firm that provides services in civil engineering, planning, landscape architecture, construction management, survey and environmental services for public and private clients. Our employees enjoy a comprehensive benefits package to include outstanding health care, generous 401(k) match, career mapping and...

Who We Are:TransPerfect is the world's largest provider of language services and technology solutions for global business. From offices in over 100 cities on six continents, TransPerfect offers a full range of services in 170+ languages to clients worldwide. More than 5,000 global organizations employ TransPerfect's GlobalLink® technology to simplify...

At CVS Health, we're committed to delivering innovative solutions that make healthcare more personal, convenient and affordable.Position OverviewWe're seeking a skilled Behavioral Health Clinical Utilization Specialist to join our team. As a key member of our clinical team, you'll play a critical role in assessing the appropriateness of treatment plans and...

Job Description We're looking for a Utilization Management Assistant, Team Lead, someone who's ready to grow with our company. In this position you will provide leadership support and oversight of daily inventory of cases/authorizations and UM processes to ensure compliance. Provide assistance or information regarding member and provider needs regarding...

Job Description We're looking for a Utilization Management Physical a Therapy Specialist, someone who's ready to grow with our company. In this position you will provide prior authorization of outpatient and home physical and occupational therapy services requiring authorization. This process includes using clinical judgement for utilization management,...

Job Summary:The Utilization Review Specialist at St. Joseph Medical Center is responsible for ensuring the medical necessity of patient admissions and continued stays. This role involves reviewing patient medical records, evaluating the appropriateness of care, and completing required forms.Key Responsibilities:Reviews patient medical records to collect data...

Job Description We're looking for a Utilization Management Physical a Therapy Specialist, someone who's ready to grow with our company. In this position you will provide prior authorization of outpatient and home physical and occupational therapy services requiring authorization. This process includes using clinical judgement for utilization management,...

Outpatient Nurse (RN)Position Summary: Provides nursing care through physical and mental assessments, plans of care and therapeutic treatments of Partial Hospitalization Patients. Knowledgeable of a wide range of disorders; cognitive, emotional, developmental, social and behavioral. Performs crisis intervention. Participates in the department's performance...