Utilization Review Nurse

Job DescriptionAbout CarolinaEast Medical CenterCarolinaEast Health System is dedicated to quality and compassionate care across the Coastal Carolina region. The flagship of the health system is a 350 bed full service medical center housing a complete complement of inpatient and outpatient services with the latest technology. CarolinaEast Health System...

About UsCarolinaEast Health System is a leading medical center in the Coastal Carolina region, dedicated to providing high-quality care with compassion and integrity. Our comprehensive services include a full range of inpatient and outpatient services, utilizing the latest technology to deliver exceptional patient outcomes. As an integral part of our team,...

About CarolinaEast Medical CenterCarolinaEast Health System is a leading healthcare provider in the Coastal Carolina region, committed to delivering high-quality, compassionate care to our patients. We are dedicated to creating a culture of excellence that connects our patients to the same level of care found at larger medical centers while maintaining a...

Our Vision and ValuesAt CarolinaEast Health System, we share a common goal of delivering exceptional patient care and improving the health and wellness of our community. Our core values include:• Respect and empathy for every patient, family member, and colleague• Dedication to delivering quality care with compassion and integrity• Teamwork and...

Silver Cross Hospital is an extraordinary place to work. We're known for our culture of excellence and delivery of unrivaled experiences for our patients, their families, the communities we serve...and for each other. Come join us! It's the way you want to be treated. Position Summary: Performs medical record review for severity of illness and intensity of...

Job Summary:SUNY Downstate Health Sciences University's Department of Care Management is seeking an experienced Utilization Review Nurse Specialist to support the review and management of patient care services.Key Responsibilities:* Complete and send initial clinical reviews within 48 hours of admission to payors via Care Management Module, CarePort.*...

About the RoleThe Nurse Case Manager - Utilization Review position at SUNY Downstate Health Sciences University offers an exciting opportunity for a seasoned Nurse to leverage their expertise in case management and utilization review to improve patient outcomes.This role requires a strong background in nursing and case management, as well as excellent...

We are seeking a skilled Registered Nurse to join our team as a Utilization Review Specialist. This role requires expertise in clinical reviews and experience with Interqual or Milliman.About the JobAs a Utilization Review Specialist, you will be responsible for reviewing patient cases to determine the level of care required. You will work closely with...

RN- Utilization Review Nurse Inpatient * Full Time - 100% Remote Opportunity* COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home as you will be...

RN- Utilization Review Nurse Inpatient *Full Time - 100% Remote Opportunity* COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home as you will be...

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. **Hours: 8:30am-5pm EST; Monday-Friday** **Must have a New York State license...

We are seeking an experienced Medical Professional to join our team as a Utilization Review nurse in Manhattan, Kansas.Job Summary:Voca is a leading healthcare staffing agency that offers travel nursing opportunities to skilled professionals. As a Utilization Review nurse with Voca, you will have the opportunity to work with top healthcare organizations and...

OverviewAt MJHS, we are dedicated to providing exceptional healthcare services to our patients and members. Our team of professionals works collaboratively to ensure that our health plans meet the needs of our diverse population.In this role as a Managed Care Nurse - Utilization Review Specialist, you will play a critical part in reviewing cases and...

Job Overview: Fastaff Travel Nursing is seeking a highly skilled medical professional to fill a utilization review position in New York.Estimated Salary: $140,000 per year, based on industry standards and location factors.About the Job: As a travel nurse RN, you will be responsible for conducting thorough utilization reviews to ensure patients receive the...

Job DescriptionTitle: Care Manager - EDShift: 9am-5pm Hybrid (40 hours weekly)Location: New York, NY 10037Duration: 13 Weeks (Possible Extension)Pay: $52/hr. Job Summary:• Review and evaluate the assessment and UAS information for members in the MLTC and MAP lines of business. • Develop a working relationship with the PCP to be able to contact and...

**Job Title:** Utilization Review CoordinatorEstimated Salary: $63,400 (based on NYC location and industry standards)At New York State Office of Mental Health, we are seeking a highly skilled Utilization Review Coordinator to join our team. As a key member of our clinical quality team, you will be responsible for reviewing medical records and analyzing data...

Job Description: Title: Care Manager - ED Shift: 9am-5pm Hybrid (40 hours weekly) Location: New York, NY 10037 Duration: 13 Weeks (Possible Extension) Pay: $52/hr. Job Summary: • Review and evaluate the assessment and UAS information for members in the MLTC and MAP lines of business. • Develop a working relationship with the PCP to be able to...

Job Description: Title: Care Manager - ED Shift: 9am-5pm Hybrid (40 hours weekly) Location: New York, NY 10037 Duration: 13 Weeks (Possible Extension) Pay: $52/hr. Job Summary: • Review and evaluate the assessment and UAS information for members in the MLTC and MAP lines of business. • Develop a working relationship with the PCP to be able to...

Job Title: Utilization Management / Appeals RN Must have BSN*** Location: Onsite required; offices in Lake Success/New Hyde Park, NY Hours: M-F 8-5 *flexible Start date: ASAP Pay: $48-54/hr *DOE Experience: UM, Appeals, or strong clinical and analytical background to do claims adjudication. Volume: Will do appeals work under the IDR team handling on...

Job OverviewMJHS is a leading healthcare organization dedicated to providing high-quality care and services to our patients and members. As a Healthcare Utilization Review Specialist, you will play a critical role in ensuring that our health plan members receive the necessary services and support to maintain their independence and quality of life.