Current jobs related to Utilization Review Nurse - Portland - Innovative Care Management Inc
-
Utilization Review Nurse
4 weeks ago
Portland, United States Martins Point Health Care Full timeJoin Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an...
-
Utilization Review Nurse
2 weeks ago
Portland, Oregon, United States Martins Point Health Care Full timeJob SummaryMartin's Point Health Care is seeking a skilled Utilization Review Nurse to join our team. As a key member of our Health Management Department, you will play a critical role in ensuring the receipt of high-quality, cost-efficient medical outcomes for our enrollees.Key ResponsibilitiesReview prior authorization requests for medical necessity,...
-
Utilization Review Nurse
6 days ago
Portland, Maine, United States Martins Point Health Care Full timeAt Martins Point Health Care, we're committed to transforming our healthcare system while creating a healthier community.As a Utilization Review Nurse, you'll be part of a team that ensures high-quality, cost-efficient medical outcomes for our enrollees.This role involves reviewing prior authorization requests, notifications of emergent hospital admissions,...
-
Maternal Nurse Reviewer
2 weeks ago
Portland, Oregon, United States Greenlife Healthcare Staffing Full timeJob Title: Maternal Nurse ReviewerWe are seeking a skilled Maternal Nurse Reviewer to join our team at Greenlife Healthcare Staffing. As a Maternal Nurse Reviewer, you will be responsible for conducting clinical reviews of medical records from various sources, as well as other documents crucial to the reviews. Your expertise in obstetrical care and...
-
Maternal Nurse Reviewer
1 month ago
Portland, Oregon, United States Greenlife Healthcare Staffing Full timeMaternal Nurse Reviewer Job DescriptionGreenlife Healthcare Staffing is seeking a skilled Maternal Nurse Reviewer to join our team. As a Maternal Nurse Reviewer, you will be responsible for conducting clinical reviews of medical records from various sources, as well as other documents crucial to the reviews. Your expertise will be utilized to develop and...
-
Maternal Nurse Reviewer
2 months ago
Portland, Oregon, United States Greenlife Healthcare Staffing Full timeMaternal Nurse Reviewer Job DescriptionWe are seeking a skilled Maternal Nurse Reviewer to join our team at Greenlife Healthcare Staffing. As a Maternal Nurse Reviewer, you will be responsible for conducting clinical reviews of medical records and providing technical assistance to program personnel.Responsibilities:Conduct comprehensive reviews of medical...
-
Maternal Nurse Reviewer
1 month ago
Portland, Oregon, United States Greenlife Healthcare Staffing Full timeMaternal Nurse Reviewer Job DescriptionGreenlife Healthcare Staffing is seeking a skilled Maternal Nurse Reviewer to join our team. As a Maternal Nurse Reviewer, you will be responsible for conducting clinical reviews of medical records and providing technical assistance to program personnel.Responsibilities:Conduct clinical reviews of medical records from...
-
Maternal Nurse Reviewer
3 weeks ago
Portland, Oregon, United States Greenlife Healthcare Staffing Full timeJob Title: Maternal Nurse ReviewerWe are seeking a skilled Maternal Nurse Reviewer to join our team at Greenlife Healthcare Staffing. As a Maternal Nurse Reviewer, you will be responsible for conducting clinical reviews of medical records and providing technical assistance to program personnel.Responsibilities:Conduct clinical reviews of medical records from...
-
Maternal Nurse Reviewer
1 month ago
Portland, United States Greenlife Healthcare Staffing Part time $50Maternal Nurse Reviewer / Contract - Metropolitan Area (#25009)Minimum of 4 years clinical practice experience in a facility or community-based settingGreenlife Healthcare Staffing is currently seeking a Maternal Nurse Reviewer to fill an opening with a Non-profit organization located in New YorkRequirements of the Maternal Nurse Reviewer:Must be qualified...
-
Maternal Nurse Reviewer
3 months ago
Portland, United States Greenlife Healthcare Staffing Part time $50Maternal Nurse Reviewer / Contract - Metropolitan Area (#25009)Minimum of 4 years clinical practice experience in a facility or community-based settingGreenlife Healthcare Staffing is currently seeking a Maternal Nurse Reviewer to fill an opening with a Non-profit organization located in New YorkRequirements of the Maternal Nurse Reviewer:Must be qualified...
-
Registered Nurse Maternal Reviewer
2 days ago
Portland, United States Greenlife Healthcare Staffing Part time $50Registered Nurse Maternal Reviewer / Per Diem - Metropolitan Area (#25035)Greenlife Healthcare Staffing is currently seeking a Registered Nurse Maternal Reviewer to fill an opening with a Non-profit organization located in New YorkRequirements of the Maternal Nurse Reviewer:Must be qualified, and actively credentialed/registered in New York State (e.g....
-
Registered Nurse Maternal Reviewer
3 months ago
Portland, United States Greenlife Healthcare Staffing Part time $50Registered Nurse Maternal Reviewer / Per Diem - Metropolitan Area (#25035)Minimum of 2 years of clinical practice experience in pediatric/adolescent/reproductive health care is preferredGreenlife Healthcare Staffing is currently seeking a Registered Nurse Maternal Reviewer to fill an opening with a Non-profit organization located in New YorkRequirements of...
-
Campus Ambassador
3 months ago
Portland, United States The Princeton Review Full timePosting Details Job Details Description As The Princeton Review’s Campus Ambassador, you will be the vital link between your school campus and our local office. Campus Ambassadors are essential to our ability to forge new relationships and nurture existing ones. They serve as our primary points of contact with student groups, increase...
-
Document Review Attorney
2 weeks ago
Portland, Oregon, United States LHH Recruitment Solutions Full timeJob DescriptionJob Title: Document Review Attorney (Japanese Fluency)Location: RemotePay Rate: $75/hr. (w2)Employment Type: ContractJob Description: LHH Recruitment Solutions is seeking highly skilled Document Review Attorneys to join their team for upcoming assignments of various durations. Candidates must possess a Juris Doctor (JD) degree, hold an active...
-
Utilization Management Coordinator
4 weeks ago
Portland, Oregon, United States Kaiser Permanente Full timeJob Summary:As a Utilization Management Member Notices Coordinator at Kaiser Permanente, you will play a critical role in ensuring compliance with federal, state, and contractual laws and regulations. Your primary responsibility will be to review and process utilization review denials, ensuring that they are completed in accordance with all applicable laws,...
-
Medical Bill Review Specialist
2 weeks ago
Portland, Oregon, United States CorVel Corporation Full timeJob SummaryCorVel Corporation is seeking a highly skilled Medical Bill Review Analyst to join our team in Portland, OR. As a Medical Bill Review Analyst, you will be responsible for reviewing, auditing, and data-entering medical bills for multiple states and lines of business.Key ResponsibilitiesAudit medical bills to ensure they are accurate and adhere to...
-
Portland, United States Kaiser Permanente Full timeJob Summary: Decrease plan exposure to bad faith or breach of contract lawsuits, regulatory sanctions, and adverse media by ensuring utilization review denials are completed in compliance with federal/state/contractual laws/regulations, plan policy and legal principles. Advise and assist operations managers, physicians and staff who participate in...
-
Logistics Coordinator for Utility Projects
6 days ago
Portland, Oregon, United States Insight Global Full timeJob Summary: We are seeking a highly skilled Logistics Coordinator for Utility Projects to support our clients' projects team on a multi-year contract.The successful candidate will work within SAP to review and prepare reports, providing recommendations to utility project managers and the legal team. Prior experience and knowledge of utility materials such...
-
Power Utility Design Supervisor
2 weeks ago
Portland, Oregon, United States Sigma Technologies (Ohio) Full time{"**Job Title:** Power Utility Design Supervisor **Job Summary:** We are seeking a highly skilled Power Utility Design Supervisor to join our team at Sigma Technologies (Ohio). The successful candidate will be responsible for leading a team of designers and engineers in the development of power utility projects. **Key Responsibilities:** * Provide...
-
Distribution Engineer
2 weeks ago
Portland, Maine, United States Leidos Full timeJob Title: Distribution Engineer - Electric Utility DesignAt Leidos, we're seeking a skilled Distribution Engineer to join our Power Delivery team. As a key member of our team, you'll be responsible for designing and developing electrical overhead and underground distribution systems for our utility customers.Key Responsibilities:Develop design and...
Utilization Review Nurse
2 months ago
Job Type
Full-time
Description
Position Summary:
Under the general direction of the Manager, Utilization Review Program, the Utilization Review (UR) Nurse is responsible for assuring prompt, accurate handling of initial medical necessity reviews through the preauthorization and retrospective review process.
Work Location:
This is a remote position, however due to payroll and tax considerations, we are only hiring candidates located in the following states: Arizona, Oregon or Washington. Applicants must reside or relocate to one of these states to be considered for the role.
Specific Position Requirements & Responsibilities:
- Review precertification requests for medical necessity.
- Refer requests to the Appeals Specialist nurse when additional expertise is required.
- Review clinical information for concurrent reviews, extending the length of stay as appropriate.
- Use effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to:
- Promote improved quality of care and/or life.
- Promote cost effective medical outcomes.
- Prevent unnecessary hospitalization.
- Promote efficient lengths of hospital stays.
- Provide for continuity of care.
- Ensure patients receive appropriate levels of care.
- Provide appropriate consultation to consultation to various clinical and non-clinical staff.
- Provide support and maintain cooperative working relationships with all Innovative Care Management departments.
- Provide appropriate referral to Case Management, Disease Management and Healthy Mother Baby programs.
- Accurately document all communications and patient-related interventions using ICM software.
Work Experience, Qualifications, Additional Skill and Abilities, and Professional Competencies:
- 2 years of direct patient care experience as a RN required.
- Ability to effectively communicate, both in verbal and written form.
- Strong computer skills required. This includes the ability to effectively use software to communicate with peers and patients in a remote setting, and the ability to quickly adapt to new software as needed.
- Self-motivated with the ability to take initiative and work effectively in both an independent and collaborative business environment.
- Excellent relationship management skills, including a high degree of psychological sophistication and non-aggressive assertiveness.
- Demonstrated ability to problem solve multifaceted and/or emotionally charged situations.
- Ability to engage in abstract thought.
- Ability to successfully manage conflict, negotiating "win-win" solutions.
- Strong organizational, task prioritization, and delegation skills.
- Strong focus on patient advocacy and empathy.
- Nursing Degree (RN) from Accredited School of Nursing, required.
- Bachelor's (or higher) degree in health-related field, preferred.
- Proof of successful completion of educational requirements for a Nurse (RN) as defined by the state in which the employee is to practice as well as proof of such licensure in good standing, required.
- Must obtain sufficient continuing education to maintain active licensure in each state where continuing education units (CEUs) are required.
- Ability to obtain other state licenses as required.
- Ability to maintain a secure, private workplace without interruption during the workday.
- Ability to sit or stand for 8-10 hours per day.
- Ability to wear a headset, dial, answer, and talk on a telephone for 8-10 hours per day.
- Ability to sit or stand in front of a computer screen and type on a keyboard 8-10 hours per day.
- Ability to lift and transport computer, headset, and files between office and home; less than 20 pounds as needed.
