We have other current jobs related to this field that you can find below
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RN - Prior Authorization-Concurrent - Med Surg
1 month ago
Sunrise, FL, United States Actalent Full timeRN - Prior Authorization-ConcurrentActalent is Hiring Prior Authorization Registered Nurses!! Job Description We are seeking registered nurses with at least 2 years of experience in Managed Care Prior Authorization or Concurrent Review. Clinical experience is highly desirable. The role involves handling Prior Authorization procedures via phone calls. Hard...
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Clinical Review Nurse
2 months ago
Savannah, GA, United States Centene Full timeYou 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...
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Clinical Review Nurse
1 month ago
Reno, NV, United States Centene Full timeYou 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...
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Utilization Management Nurse, Senior
3 weeks ago
United States, CA, Rancho Cordova Blue Shield of California Full timeYour Role The Utilization Management team reviews the inpatient stays for our members under the guidelines for nationally recognized levels of care. The Utilization Management Nurse, Senior will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and review clinical information provided by the...
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Utilization Review
1 month ago
Jacksonville, FL, United States Saint Vincent's Medical Center Riverside Full timeUtilization Review - Registered Nurse - RNDetails * Department: Utilization Review * Schedule: Varied - PRN * Hospital: Ascension St. Vincent's Riverside Hospital * Location: Jacksonville, FL 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
3 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...
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Utilization Review RN
2 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...
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Travel Nurse RN
3 weeks ago
Manhattan, KS, United States NuWest Travel Nursing Full timeNuWest Travel Nursing is seeking a travel nurse RN Utilization Review for a travel nursing job in Manhattan, Kansas.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNStart Date: 08/16/2024Duration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelPerks: Benefits include medical, dental, vision, 401K, weekly direct...
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Travel Nurse RN
3 weeks ago
Manhattan, KS, United States NuWest Travel Nursing Full timeNuWest Travel Nursing is seeking a travel nurse RN Utilization Review for a travel nursing job in Manhattan, Kansas.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelPerks: Benefits include medical, dental, vision, 401K, weekly direct deposit,...
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Utilization Review Clinician
4 weeks ago
Hialeah, FL, United States Centene Full timeYou 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. THERE ARE 3 POSITIONS AVAILABLE/BUILDING A NEW PROGRAM.THESE POSITIONS ARE...
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Utilization Review RN
1 month ago
Rockford, IL, United States Hines & Associates Inc Full timeDescription:ABOUT US:Hines is a nationwide, independent leader in personalized managed health care, focused on what's important to you-comprehensive services with the program excellence and cost containment that you demand. Hines & Associates, Inc.'s reputation as an industry leader is founded on over three decades of innovative and professional health care...
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Utilization Review Nurse
2 days 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...
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Utilization Review RN
4 days 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 &...
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RN-Utilization Review
3 weeks 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...
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Utilization Review Coordinator
2 days 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...
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Utilization Review Coordinator
2 days ago
Crown Point, 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...
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Case Manager/ Utilization Review RN
1 month ago
Pasco, WA, United States Lourdes Health Full timeJob DescriptionEducation & Qualifications:Graduate from an accredited school of nursing (RN) required, bachelors preferred.Knowledge and skills necessary to provide care appropriate to the population served in the CM Department.Two (2) or more year’s clinical experience preferred.Acute care or community social agency case management experience...
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Case Manager/ Utilization Review RN
1 month ago
Pasco, WA, United States Lourdes Health Full timeEducation & Qualifications: Graduate from an accredited school of nursing (RN) required, bachelors preferred. Knowledge and skills necessary to provide care appropriate to the population served in the CM Department. Two (2) or more year's clinical experience preferred. Acute care or community social agency case management experience preferred. Utilization...
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Case Manager/ Utilization Review RN
2 months ago
Pasco, WA, United States Lourdes Health Full timeEducation & Qualifications: Graduate from an accredited school of nursing (RN) required, bachelors preferred. Knowledge and skills necessary to provide care appropriate to the population served in the CM Department. Two (2) or more year’s clinical experience preferred. Acute care or community social agency case management experience preferred. Utilization...
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Peer Review Coordinator Registered Nurse RN
1 month ago
Richmond, VA, United States Henrico Doctors' Hospital Forest Full timeDescription IntroductionDo you want to be appreciated daily? Our nurses are celebrated for being on the front line, empathetic for patients. At Henrico Doctors' Hospital Forest our nurses set us apart from any other healthcare provider. We are seeking a(an) Peer Review Coordinator Registered Nurse RN to join our healthcare family.BenefitsHenrico Doctors'...
Concurrent Review RN
3 months ago
Concurrent Review Nurse Job Description As a Concurrent Review Nurse, you will review requests for service authorizations to assist with the utilization of appropriate medical services. Your responsibilities will include reviewing various medical treatments, services, home care, and out-of-plan referrals. You will assist with complex cases and internal process development, provide education to physicians and other team members on utilization review (UR) including appropriate admissions and placements, manage continuity of care, ensure safe transitions, patient and provider satisfaction, and appropriate length of stay. Hard Skills * Active nurse licensure in the state of Florida * Knowledge of case management and UR concepts * Utilization review of prior authorizations for medical necessity * Familiarity with and ability to apply InterQual criteria * Experience in a managed care facility, previously worked with a health insurance company Soft Skills * Ability to work under supervision * Effective communication skills * Capability to work as part of an interdisciplinary team Job Type This is a contract position with a duration of 6 Month(s). Work Site This is a hybrid position requiring some days on-site in SUNRISE, Florida and some days remote. Work Environment This role operates in a fast-paced environment under the supervision of a Medical Director and/or Medical Management supervisor. The shift timings are from 8:30 AM to 5:00 PM or 8:00 AM to 5:00 PM if an hour lunch is preferred. A hybrid work-from-home/office model is currently in place. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. Diversity, Equity & Inclusion At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through: * Hiring diverse talent * Maintaining an inclusive environment through persistent self-reflection * Building a culture of care, engagement, and recognition with clear outcomes * Ensuring growth opportunities for our people The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
