Utilization Review Nurse

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the UM program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and...

An award-winning acute care hospital located in central New York is currently searching for an experienced Nurse Manager Utilization Review to join their established healthcare system. This regional leading medical center is home to over 500 inpatient beds and provides a wide variety of awarded acute care services. This location offers exceptional...

Responsibilities Provides strategic leadership to the daily operations of the Utilization Review Department. The Utilization Review (UR) Director is responsible for overseeing the utilization management processes to ensure efficient, compliant, and clinical guideline-aligned care. Oversees the utilization review, organization's determination and...

Description Oversee utilization management and review of patients care delivery while in the hospital and provide clinical reviews and denial appeals where appropriate either during admission or post discharge. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Regional Medical Center Everett and thrive in our...

City/State Norfolk, VAOverviewWork Shift First (Days) (United States of America)Sentara Health is hiring a Full-Time Day shiftUtilization Review RN Case Managementfor the Revenue Cycle Center in Norfolk, VA. The position is located in Norfolk, VA and currently offering a hybrid opportunity. Minimum Job Requirements: 3 years of acute care RN experience....

Description:LPNs - are you looking for a change? Want to work no nights, no weekends, and no holidays? Be able to work from home 50% of the time once trained? Check out Hines & Associates!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...

Description:Nurses - are you looking for a change? Want to work no nights, no weekends, and no holidays? Be able to work from home 50% of the time once trained? Check out Hines & Associates! 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...

Salary : $187,807.36 - $239,763.68 Annually Location : Throughout the County of Santa Clara, CA Job Type: Full-Time/Part-Time Job Number: 25-S12-A Department: Santa Clara Valley Health Care - Valley Medical Center Opening Date: 01/24/2025 Closing Date: 2/7/2025 11:59 PM Pacific Bargaining Unit: 92 Description Under direction, to review, monitor and assess...

Job SummaryThe Utilization Review (UR) Nurse is a key member of the healthcare team at Shannon Health, responsible for ensuring that our patients receive the most effective and efficient care possible. As a UR Nurse, you will utilize your acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination...

Job Description The Utilization Review Case Manager requires effective communication and coordination with the Director of Utilization Review, insurance companies, and treatment team to obtain the maximum benefits for our clients. The Utilization Review Case Manager will submit accurate utilization reviews on an extremely tight...

Job Summary: Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in the discharge planning process. Essential Responsibilities: Conducts utilization review for in-house patients and/or members who have been admitted to contracted facilities. Interviews patients/caregivers regarding care after...

Job Summary: Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in the discharge planning process. Essential Responsibilities: Conducts utilization review for in-house patients and/or members who have been admitted to contracted facilities. Interviews patients/caregivers regarding care after...

TEMPORARY POSITION FLSA Status: Non-Exempt Department: Health Services Reports To: Health Services Management GENERAL DESCRIPTION OF POSITION Under the guidance and direction of the UM department RN Manager or Director, the Utilization Management Review Nurse (LVN) performs prospective and retrospective clinical review for inpatient and outpatient...

Job Summary:Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in the discharge planning process.Essential Responsibilities:Conducts utilization review for in-house patients and/or members who have been admitted to contracted facilities. Interviews patients/caregivers regarding care after...

***REMOTE - Candidates must be based in Texas: Travis/Williamson/Dallas/Collin Counties***JOB DESCRIPTION: RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. JOB RESPONSIBILITIES: This position is responsible for performing initial, concurrent...

The Hospital Assistant Director Utilization Review RN will work for a non-profit health system, known for their acute care hospital, walk-in centers, and speciality services. The highly accredited 200+ bed acute care hospital received The Joint Commission s Gold Seal of Approval for their Joint Replacement, Stroke, and Heart Failure programs. The Hospital...

***REMOTE - Candidates must be based in Texas: Travis/Williamson/Dallas/Collin Counties*** JOB DESCRIPTION: RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. JOB RESPONSIBILITIES: This position is responsible for performing initial, concurrent...

-Title - Patient Care Coordinator /Utilization RNDuration - 13 weeks (Extendable)Shift - Days 08:00 AM to 04:30 PMDescription:Job Summary:Coordinates with physicians, providers and facilities regarding patients transitions and discharge planning. In conjunction with physicians, develops plans of care and discharge plans, and makes recommendations for...

Description: Job Summary: Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in the discharge planning process. Essential Responsibilities: Conducts utilization review for in-house patients and/or members who have been admitted to contracted facilities. Interviews patients/caregivers regarding care after...

Manager of Utilization Review/Case ManagementSilicon Valley near San JoseOne of CA's most desirable communities in the heart of Silicon Valley!America's leading nonprofit integrated health plan, my client serves more than 9 million people from 35 hospitals and 431 medical office buildings in nine states and the District of Columbia. Thanks to the dedication...