Utilization Review Nurse

Job DescriptionMedRisk is seeking a skilled Clinical Reviewer to join our team in the utilization review program. As a Clinical Reviewer, you will play a critical role in promoting quality outcomes and enhancing the physical, psychosocial, and vocational health of individuals.Key Responsibilities:Evaluate medical data for utilization review requests and...

About MarinHealth Medical CenterMarinHealth Medical Center is a leading healthcare provider in the North Bay, offering a unique blend of academic medicine and personalized care. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive the right care at the right time.Job SummaryThe Utilization Review Nurse is responsible...

Job SummaryThe Utilization Review Nurse is a key member of the Care Coordination team at Actalent, responsible for ensuring the most effective and efficient use of healthcare resources. This role requires a strong understanding of healthcare systems, policies, and procedures, as well as excellent communication and collaboration skills.Key...

Job SummaryThe Utilization Review Nurse is a key member of the Care Coordination team at Actalent. This role involves coordinating continuing care and outside services for value-based risk members, collaborating with hospitals and primary care physicians to ensure optimal patient outcomes.Responsibilities include:Repatriating stable members from non-member...

San Jose Behavioral Health is seeking an experienced Utilization Review Specialist to coordinate and assess the inpatient census for appropriate alternate health care service needs.The ideal candidate will have a degree in Nursing from an accredited college, and possession of a current nursing licensure (i.e. LVN, LPT, RN). Qualified candidates will have 3-5...

Job Title: Healthcare Utilization Review SpecialistCare Review Clinician, Prior Authorization (Registered Nurse, or LVN)Key Responsibilities:Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.Refers appropriate prior authorization requests to Medical Directors.Collaborates with multidisciplinary...

Job Title: Travel Nurse - Utilization Review SpecialistJob Summary: We are seeking a skilled Travel Nurse - Utilization Review Specialist to join our team at Healthcare Staffing Plus. As a key member of our healthcare team, you will be responsible for assisting in the development and maintenance of policies and procedures related to utilization management....

Job DescriptionAurora San Diego seeks a skilled Utilization Review Specialist to join our team. In this role, you will work as a member of a multi-disciplinary treatment team, reviewing patient care and treatment options for both inpatient and outpatient services.Key Responsibilities:Conduct admission reviews to ensure patients receive appropriate...

Job Title: Travel Registered Nurse Utilization Review SpecialistJob Summary:Healthcare Staffing Plus is seeking a skilled Travel Registered Nurse Utilization Review Specialist to join our team. As a Utilization Review Registered Nurse, you will be responsible for assisting in developing and maintaining policies and procedures for the Service Area or Medical...

Job SummaryThe Utilization Management Review Nurse LVN is responsible for conducting clinical reviews to ensure effective and appropriate utilization of benefits and services for prospective, concurrent, and retrospective/claims review organization determination authorization requests within regulatory turnaround requirements for all SCFHP lines of...

Job Title: Travel Registered Nurse - Utilization Review SpecialistJob Summary:We are seeking a skilled Travel Registered Nurse - Utilization Review Specialist to join our team at Healthcare Staffing Plus. As a Utilization Review Specialist, you will play a critical role in developing and maintaining policies and procedures for the Service Area or Medical...

Job SummaryWe are seeking a skilled Utilization Management Review Nurse LVN to join our team at Santa Clara Family Health Plan. As a key member of our Health Services department, you will play a critical role in ensuring the effective and appropriate utilization of benefits and services for our members.Key ResponsibilitiesConduct clinical reviews to assess...

Job Description:RN Case Manager Job Requirements:As a RN Case Manager with HexaQuEST Health, Inc., you will be responsible for conducting patient initial assessments, utilizing your strong Utilization Review experience to ensure the best possible outcomes. You will work in an acute Care hospital setting, utilizing your EPIC EMR documentation skills to...

Job Title: CA RN Case Manager (Strong Utilization Review Expertise Required)We are seeking a skilled RN Case Manager with strong utilization review expertise to join our team at HexaQuEST Health, Inc.Key Responsibilities:Conduct patient initial assessments and provide high-quality careUtilize strong utilization review skills to ensure efficient and effective...

Job SummaryWe are seeking a skilled Travel Registered Nurse - Utilization Review Specialist to join our team at Healthcare Staffing Plus. As a key member of our team, you will be responsible for assisting in the development and maintenance of policies and procedures related to utilization management.Key Responsibilities:Collaborate with multi-disciplinary...

Job SummaryThe Utilization Management Nurse is a key member of our interdisciplinary team, responsible for evaluating the efficiency and appropriateness of treatments and services provided to patients. This role requires strong clinical expertise, excellent communication skills, and the ability to work collaboratively with healthcare professionals to ensure...

Job SummarySan Francisco Health Plan is seeking a skilled Concurrent Review Coordinator to join our team. As a key member of our healthcare team, you will play a vital role in supporting the Concurrent Review process, working closely with a multi-disciplinary team to ensure seamless care transitions for our members.Key Responsibilities• Research...

Job SummaryAs a Utilization Management Nurse, RN, you will play a critical role in ensuring that our Members receive the necessary care and services to achieve optimal health outcomes. This position requires a strong understanding of healthcare regulations, policies, and procedures, as well as excellent communication and analytical skills.Key...

Job SummaryThe Utilization Management Nurse Case Manager is responsible for the appeal process for the inpatient adult population. This role involves working with admitting, patient financial services, physicians, nurses, and case managers to ensure that patients receive the necessary treatments and services.Key ResponsibilitiesReview admission reviews and...

Job SummaryThe Utilization Management Nurse is responsible for the appeal process for the inpatient adult population and is an active participant of the Medicare one day stays process. The incumbent works in a collaborative relationship with admitting, patient financial services, physicians, nurses, case managers and social workers of the interdisciplinary...