Utilization Review Nurse
1 week ago
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
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Utilization Review Nurse
Found in: Jooble US O C2 - 2 weeks ago
Meadowbrook, PA, United States Holy Redeemer Hospital and Medical Center Full timeUtilization 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...
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Utilization Review Nurse
1 week ago
Meadowbrook, United States Holy Redeemer Hospital and Medical Center Full timeUtilization 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...
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Utilization Review Nurse
1 week ago
Meadowbrook, United States Holy Redeemer Hospital and Medical Center Full timeUtilization 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...
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UTILIZATION REVIEW NURSE
Found in: Careerbuilder One Red US C2 - 3 days ago
Meadowbrook, PA 19006, USA, United States Holy Redeemer Health System Full timePer Diem1648 Huntingdon PikeNursing RN/LPNDaySUMMARY 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...
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UTILIZATION REVIEW NURSE
Found in: Careerbuilder One Red US C2 - 3 days ago
, VT, United States Central Vermont Medical Center Full timeBuilding Name: HHH - In-State Hybrid/RemoteRegularDepartment: CVMC - Care ManagementFull TimeStandard Hours: 40Biweekly Scheduled Hours:Shift: DayPrimary Shift: 7:30 AM - 4:00 AMWeekend Needs: NoneRecruiter: Kate DaviesPOSITION SUMMARYThe Utilization Review Nurse is responsible for ensuring the medical necessity and appropriate level of care of all hospital...
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Utilization Review Nurse
6 days ago
Colchester, VT, United States The University of Vermont Health Network Full timePOSITION SUMMARYThe Utilization Review Nurse is responsible for ensuring the medical necessity and appropriate level of care of all hospital admissions and extended hospital stays, including psychiatry; affirming compliance with CMS’ Conditions of Participation regarding Utilization Management with annual review of the UM Plan and assisting with the...
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Utilization Review Nurse
Found in: Careerbuilder One Red US C2 - 4 days ago
Colchester, VT, United States The University of Vermont Health Network Full timePOSITION SUMMARYThe Utilization Review Nurse is responsible for ensuring the medical necessity and appropriate level of care of all hospital admissions and extended hospital stays, including psychiatry; affirming compliance with CMS’ Conditions of Participation regarding Utilization Management with annual review of the UM Plan and assisting with the...
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UTILIZATION REVIEW RN
Found in: Careerbuilder One Red US C2 - 3 days ago
, CA, United States Marshall Medical Center Full timeDepartment:Utilization ReviewShift:Primarily Days (United States of America)Employee Type:RegularPer Diem Type (if applicable):Minimum Pay Range:$55.77 - $69.71Job Description:POSITION SUMMARYThe Utilization Review Nurse (UR RN) uses a collaborative process, which provides professional accountability for the utilization of the health care resources to the...
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Registered Nurse RN
2 weeks ago
Pensacola, FL, United States Sacred Heart Hospital Full timeRegistered Nurse RN - Utilization ReviewDetails * Department: Utilization Mgt * Schedule: M-F 8 hr days, ONSITE, exempt * Hospital: Ascension Sacred Heart Pensacola * Location: Pensacola, Florida Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term...
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RN UTILIZATION REVIEW
Found in: Careerbuilder One Red US C2 - 3 days ago
, NC, United States Cone Health Full timeOverviewPerforms admission and continued stay utilization reviews and discharge screening to assure the medical necessity of hospital admission, appropriate level of care, continued stay and supportive services, and to examine delays in the provision of services. Coordinates care transitions from inpatient to the next level of care. Collaborates with...
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UTILIZATION REVIEW RN PRN
Found in: Careerbuilder One Red US C2 - 3 days ago
, VA, United States Virginia Commonwealth University Health System Full timeThe Utilization Review RN PRN is responsible for utilization management and utilization review for prospective, concurrent, or retrospective review.This job functions as a part of a multidisciplinary team, including physicians, social workers, discharge planning assistants and payers, performs reviews of current inpatient services, and determines medical...
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Utilization Review RN
Found in: Careerbuilder One Red US C2 - 2 weeks ago
Boston, MA, United States Beth Israel Deaconess Medical Center Full timeWhen you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.Job Type:RegularScheduled Hours:40Work Shift:Day (United States of America)Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on the...
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Utilization Review RN
Found in: Careerbuilder One Red US C2 - 2 weeks ago
Boston, MA, United States Beth Israel Deaconess Medical Center Full timeWhen you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Job Type:Regular Scheduled Hours:40 Work Shift:Day (United States of America) Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on...
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RN- UTILIZATION REVIEW
Found in: Careerbuilder One Red US C2 - 3 days ago
, OH, United States UC Health Full timeAt UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering.As the region's adult academic health system, we strive for innovation and provide world-class care for not only our community, but patients from all over the world. Join our team and you'll be able to...
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Registered Nurse
Found in: Careerbuilder One Red US C2 - 2 weeks ago
Tyler, TX, United States UT Health Tyler Full timeOverviewJoin our team as a PRN, day shift, Utilization Review Registered Nurse in Tyler, TX. Fulfilling your purpose begins here: People First, Always. Here’s how we take care of our people:Competitive salaries, support teams and growth opportunities.Your team is bigger than your department: UT Health Tyler, the flagship hospital of the system, has 502...
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Registered Nurse
2 weeks ago
Tyler, TX, United States UT Health Tyler Full timeOverviewJoin our team as a PRN, day shift, Utilization Review Registered Nurse in Tyler, TX. Fulfilling your purpose begins here: People First, Always. Here’s how we take care of our people:Competitive salaries, support teams and growth opportunities.Your team is bigger than your department: UT Health Tyler, the flagship hospital of the system, has 502...
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Registered Nurse
2 weeks ago
Tyler, TX, United States UT Health Tyler Full timeOverviewJoin our team as a PRN, day shift, Utilization Review Registered Nurse in Tyler, TX. Fulfilling your purpose begins here: People First, Always. Here’s how we take care of our people:Competitive salaries, support teams and growth opportunities.Your team is bigger than your department: UT Health Tyler, the flagship hospital of the system, has 502...
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RN UTILIZATION REVIEW COORDINATOR
Found in: Careerbuilder One Red US C2 - 3 days ago
, AZ, United States Maricopa Integrated Health System Full timeAs a Valleywise Utilization Review RN Coordinator, you are part of a multidisciplinary team providing exceptional care to our patients. As a Utilization Review RN Coordinator, you work under the direction of the Manager of Care Management as part of the inpatient Care Management Team. You are responsible for determining the appropriateness of patient status...
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Utilization Review RN- Onsite
7 days ago
Plattsburgh, NY, United States The University of Vermont Health Network Full timePlease 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...
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Utilization Review RN- Onsite
Found in: Careerbuilder One Red US C2 - 14 hours ago
Plattsburgh, NY, United States The University of Vermont Health Network Full timePlease 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...