Current jobs related to Utilization Review/Management Nurse - Albuquerque - HireOps Staffing LLC

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  Clinical Utilization Review Nurse

  6 days ago

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  Albuquerque, New Mexico, United States HireOps Staffing LLC Full time

  Job SummaryWe are seeking a skilled Nurse Case Manager Coordinator to join our team at HireOps Staffing LLC. As a key member of our healthcare team, you will be responsible for performing concurrent review, discharge planning, and identifying alternate treatment programs.Key ResponsibilitiesConduct episodic case management, consulting, and collaborating with...

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  Clinical Utilization Review Specialist

  1 week ago

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  Albuquerque, New Mexico, United States University of New Mexico Full time

  Utilization Review RNWe are seeking a highly skilled Registered Nurse to join our Utilization Review team at the University of New Mexico. In this role, you will review hospital admissions and continued stays for medical necessity and manage insurance authorizations throughout the patient's stay. You will coordinate patient care and ensure quality,...

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  RN - Utilization Review Specialist

  2 weeks ago

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  Albuquerque, New Mexico, United States University of New Mexico - Hospitals Full time

  Job SummaryWe are seeking a skilled RN to join our Utilization Review team as a Per Diem Case Manager. In this role, you will be responsible for reviewing admissions and continued stays to ensure medical necessity and managing insurance authorization throughout the hospital stay.Key ResponsibilitiesCoordinate all systems and services required for an...

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  RN - Utilization Review Specialist

  2 weeks ago

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  Albuquerque, New Mexico, United States University of New Mexico - Hospitals Full time

  Job SummaryWe are seeking a skilled RN to join our Utilization Review team as a Per Diem Case Manager. In this role, you will be responsible for reviewing admissions and continued stays to ensure medical necessity and managing insurance authorization throughout the hospital stay.Key ResponsibilitiesCoordinate all systems and services required for an...

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  Utilization Management Reviewer-Long Term Care

  4 weeks ago

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  Albuquerque, United States Presbyterian Healthcare Services Full time

  Overview Now hiring a Utilization Management Reviewer-Long Term Care Responsible for conducting Nursing (NF) Facility Level of Care (LOC) determinations according to state regulations and criteria. Performs utilization review activities to ensure that services rendered to members meet Long Term Care Supports and Services (LTSS) criteria and services are...

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  RN - Utilization Review Specialist

  3 days ago

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  Albuquerque, New Mexico, United States University of New Mexico - Hospitals Full time

  Job SummaryWe are seeking a skilled RN to join our Utilization Review team as a Per Diem Case Manager. In this role, you will play a critical part in ensuring that patients receive the highest quality care while minimizing unnecessary hospital stays.Key ResponsibilitiesConduct thorough assessments of patient needs and develop individualized care...

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  RN - Utilization Review Specialist

  2 weeks ago

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  Albuquerque, New Mexico, United States University of New Mexico - Hospitals Full time

  Job SummaryWe are seeking a skilled RN to join our team as a Utilization Review Specialist. This per diem position will play a critical role in ensuring the quality and cost-effectiveness of patient care.Key ResponsibilitiesConduct thorough assessments of patient needs and develop comprehensive care plansCollaborate with healthcare teams to ensure seamless...

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  Regional Nurse

  2 weeks ago

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  Albuquerque, New Mexico, United States Wexford Health Sources Inc Full time

  About Wexford Health Sources Inc.We are a leading provider of correctional healthcare services, dedicated to delivering high-quality medical and mental health care to justice-involved patients. Our team of clinical professionals is committed to making a positive impact on the lives of our patients and their families.Job SummaryWe are seeking a skilled and...

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  Utilization Management Specialist

  4 weeks ago

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  Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

  About the RoleWe are seeking a skilled Utilization Management Reviewer-Long Term Care to join our team at Presbyterian Healthcare Services. As a critical member of our team, you will play a key role in ensuring that our members receive the best possible care.Key ResponsibilitiesConduct thorough reviews of medical documentation to determine the level of care...

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  Clinical Utilization Management Nurse Expert

  4 weeks ago

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  Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

  OverviewWe are seeking a Clinical Utilization Management Nurse Expert. This position offers the flexibility of remote work.The role involves conducting clinical evaluations to confirm that services provided to members align with clinical standards and are administered in suitable environments. Employing clinical expertise, you will coordinate, document, and...

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  Utilization Management Reviewer-Long Term Care

  4 weeks ago

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  Albuquerque, United States Presbyterian Healthcare Services Full time

  Responsible for the review of all required medical documentation against HSD criteria and to provide an objective evaluation and determination of NF LOC medical eligibility (approvals and denials). Documents recommendations and NF LOC determinations Management, Medical Director, Healthcare, Benefits

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  Utilization Management Coordinator

  2 days ago

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  Albuquerque, New Mexico, United States Health Care Service Corporation Full time

  Job SummaryThis position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and medical and network management divisions.Collects clinical and non-clinical data. Verifies eligibility....

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  Clinical Review Coordinator

  2 weeks ago

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  Albuquerque, New Mexico, United States UnitedHealth Group Full time

  About the RoleWe are seeking a highly skilled Clinical Review Coordinator to join our team at UnitedHealth Group. As a Clinical Review Coordinator, you will play a critical role in optimizing patients' recovery journeys by completing weekly functional assessments and engaging the post-acute care (PAC) inter-disciplinary care team to coordinate discharge...

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  HEDIS Review Nurse Specialist

  6 hours ago

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  Albuquerque, New Mexico, United States w3r Consulting Full time

  Job Summary:An experienced Registered Nurse (RN) is sought to join our team at w3r Consulting as a HEDIS Review Nurse. The successful candidate will be responsible for conducting annual patient chart inspections/audits to ensure compliance with standards of patient care set forth by insurance companies.Key Responsibilities:Abstract medical record...

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  Utilization Management Coordinator

  3 weeks ago

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  Albuquerque, New Mexico, United States Health Care Service Corporation Full time

  Job SummaryThis position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services and serving as liaison between providers and Medical and Network Management Divisions.Key Responsibilities:Reviews service requests, collects clinical and...

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  Clinical Review Coordinator

  1 month ago

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  Albuquerque, United States UnitedHealth Group Full time

  Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere. As a team...

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  Mandarin Document Review Attorney

  1 week ago

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  Albuquerque, New Mexico, United States Contact Government Services, LLC Full time

  About the RoleWe are seeking a skilled Mandarin document reviewer to join our team at Contact Government Services, LLC. As a contract attorney, you will be responsible for reviewing and analyzing documents in Mandarin Chinese, utilizing your expertise in document review workflows and electronic document review technology.Key ResponsibilitiesReview and...

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  Utility ROW Permit Manager

  2 weeks ago

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  Albuquerque, New Mexico, United States TEKsystems Full time

  Job SummaryWe are seeking a highly organized and detail-oriented Permitting Specialist to join our team at TEKsystems. As a Permitting Specialist, you will be responsible for managing and maintaining project and program artifacts, communicating with project team members, and assisting with all aspects of project management and permitting tasks.Key...

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  Senior Case Manager

  7 days ago

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  albuquerque, United States Professional Case Management Full time

  Make a Difference on Your Own Schedule and Terms! Hiring Senior Case Managers in New Mexico br>(including 100% of Hourly Wage Paid for All Drive Time)Bonus EligibleDirect assigned team members of RN Case Managers in the provision of care in accordance with Agency policy and with state-specific nurse practice act, and regulatory requirements Graduate of a...

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  Senior Case Manager

  2 days ago

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  albuquerque, United States Professional Case Management Full time

  Make a Difference on Your Own Schedule and Terms! Hiring Senior Case Managers in New Mexico Come join our growing team! A few of our perks: Create your own schedule!$42/hr.(including 100% of Hourly Wage Paid for All Drive Time)Bonus EligibleDirect assigned team members of RN Case Managers in the provision of care in accordance with Agency policy and with...