Utilization Review Nurse or Specialist

Company OverviewSUNY Downstate Medical Center is a leading healthcare provider in the region, committed to delivering exceptional patient care and advancing medical knowledge. Our team of dedicated professionals shares a passion for excellence and a commitment to making a difference in the lives of our patients and communities.Job SummaryWe are seeking a...

About Us We are a psychiatric healthcare system, dedicated to providing mental healthcare for all, with seven locations in the Minneapolis/St. Paul metro area, and two additional sites located in Rochester and Mankato. With a robust benefits package, career advancement opportunities, and great workplace culture, we value our employees and the work they do...

The Department of Care Management at SUNY Downstate Health Sciences University is seeking a full-time Utilization Review Nurse / TH Utilization Review/ Quality Assurance Senior Coordinator. The successful candidate will: Complete and send initial cli Nurse, Medical Director, Healthcare, Education, Clinical, Management

Job DescriptionJob DescriptionJOB DESCRIPTIONJob Title: Utilization Review SpecialistDepartment: Utilization ReviewFLSA Status: ExemptJOB SUMMARYThe UR Specialist applies expertise of payor behavior and clinical guidelines to optimize utilization review outcomes. The UR Specialist analyzes factors that result in denials to identify opportunities for...

About the Role:We are seeking a skilled Utilization Review Registered Nurse to join our team at LifeBridge Health. This part-time position requires working every other weekend, with 24 hours bi-weekly.Responsibilities:Conduct concurrent and retrospective chart reviews for clinical, financial, and resource utilization informationCollaborate with healthcare...

About the JobSUNY Downstate Health Sciences University is seeking an experienced Utilization Review Nurse / TH Utilization Review/Quality Assurance Senior Coordinator to join our Department of Care Management. This full-time position will play a critical role in ensuring the quality and efficiency of patient care.Job SummaryUtilize clinical expertise to...

The Utilization Review Nurse performs prospective and retrospective reviews for post-acute care services. The purpose and goal of utilization management is to assure that Wellsky's population receives medically necessary services in the appropriate setting, with the appropriate provider, and at the appropriate level of care. This position is responsible for...

The Utilization Review Nurse performs prospective and retrospective reviews for post-acute care services. The purpose and goal of utilization management is to assure that Wellsky's population receives medically necessary services in the appropriate setting, with the appropriate provider, and at the appropriate level of care. This position is responsible for...

Job OverviewWe're seeking a talented healthcare professional to join our team as a travel nurse RN Case Manager, Utilization Review. As a key member of our organization, you will play a crucial role in ensuring the highest quality care for our patients.About the JobThis 13-week assignment requires a skilled RN with experience in utilization review and case...

Job OverviewWe are seeking a skilled Clinical Utilization Review Specialist to join our team in Oakland, California. This is a travel healthcare opportunity that offers the chance to work with a leading healthcare provider and contribute to the delivery of exceptional patient care.

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 SummaryAstrana Health is seeking a highly motivated and detail-oriented Clinical Review Specialist to join our team. This position will be responsible for reviewing and processing denied claims from the Utilization Management team.The ideal candidate will have a strong background in Utilization Management and excellent clinical knowledge. They will be...

Job DescriptionJob DescriptionUPS Industrial Services is accepting resumes for a Contract Review Specialist. The Contract Review Specialist is a key member of the Contract Administration team. Primary responsibilities include drafting, reviewing, redlining, negotiating, and finalizing contracts and agreements for clients and subcontractors in industries such...

About UsWest Suburban Medical Center has been a trusted healthcare provider for generations of families in the Oak Park area. Our dedicated staff is committed to delivering exceptional patient care and improving community health. We are proud to uphold our core values of Quality, Innovation, Service, Integrity, and Transparency in all aspects of our...

Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Philadelphia, Pennsylvania. Job Description & Requirements Specialty: Utilization Review Discipline: RN Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel We’re seeking talented healthcare professionals whose adventure...

We are seeking a detail-oriented Medical Records Review Specialist to join our team. In this role, you will be responsible for reviewing and analyzing medical records to ensure compliance with HEDIS/STAR measures. With a strong background in data analysis and quality chart reviews, you will work closely with our team to identify areas for improvement and...

We are seeking a skilled Clinical Reviewer to join our team at AltaStaff. As a Clinical Reviewer, you will be responsible for reviewing and making recommendations on consumer assessments for long-term care services and supports.Maintain current knowledge of regulatory changes pertaining to quality and validity of assessments, assess cases presented and...

Job SummaryWe are seeking a skilled and compassionate RN to join our team as a Hospice Nurse Specialist. The successful candidate will provide expert end-of-life care to patients with terminal illnesses, working in both home and inpatient settings.About the RoleThis is an exciting opportunity for a motivated and caring individual to make a meaningful...

We are currently seeking a talented Utility Maintenance Specialist to join our team at the Town of Orange Park. This individual will be responsible for performing maintenance, repair, and inspection tasks related to the town's water and sewer systems.Responsibilities:Assist with underground utility marking to ensure public safety and infrastructure...

About AmericareAmericare is a leading provider of home health care services, with locations in Queens, Brooklyn, Bronx, Manhattan, and Westchester Counties. Our mission is to deliver high-quality care to our patients while providing a nurturing work environment for our staff.Job SummaryWe are seeking a Medical Review Nurse to join our team in an office...