Current jobs related to Clinical Utilization Review Nurse - Overland Park, Kansas - Wellsky
-
Clinical Nurse Specialist
1 week ago
Overland Park, Kansas, United States WellSky Full timeJob SummaryThe Utilization Review Nurse is responsible for performing prospective and retrospective reviews of post-acute care services to ensure that WellSky's population receives medically necessary services in the appropriate setting, with the appropriate provider, and at the appropriate level of care.Key Responsibilities:Perform initial prior...
-
Clinical Nurse Care Coordinator
2 weeks ago
Overland Park, Kansas, United States The University of Kansas Health System Full timeJob SummaryThe University of Kansas Health System is seeking a skilled Clinical Nurse Care Coordinator to join our team. As a key member of our oncology clinic, you will play a vital role in providing exceptional patient care and ensuring seamless coordination of services.ResponsibilitiesManage patient flow, triage, and direct patient care to optimize...
-
Park City GI Clinic Nurse
1 week ago
Overland Park, Kansas, United States Intermountain Health Full timeJob Summary:The Registered Nurse (RN) is a professional caregiver who assumes responsibility and accountability for assessing, planning, implementing and evaluating care of patients.The staff RN utilizes the nursing process by use of technology, therapeutic intervention, evidence-based practice and coordination of care with other health team members.Key...
-
Clinical Nurse Practitioner
4 weeks ago
Overland Park, Kansas, United States Family Health Medical Group Full timeJoin Our Team as a Licensed Practical NurseWe are committed to providing high-quality patient care and are seeking a skilled Licensed Practical Nurse to join our team at Family Health Medical Group.About the Role:Manage the efficient flow of patients, including screening, preparation for exams, and obtaining vitals.Graduation from an accredited school of...
-
Clinical Nurse Practitioner
4 weeks ago
Overland Park, Kansas, United States Family Health Medical Group Full timeJoin Our Team as a Licensed Practical NurseWe are committed to providing high-quality patient care and are seeking a skilled Licensed Practical Nurse to join our team at Family Health Medical Group.About the Role:Manage the efficient flow of patients, including screening, preparation for exams, and obtaining vitals.Graduation from an accredited school of...
-
Clinical Site Operations Manager
4 weeks ago
Overland Park, Kansas, United States Walgreens Full timeJob Description:Job SummaryThe Clinical Site Operations Manager reports to the Director of Clinical Site Operations and functions as the direct manager for patient-facing site staff supporting assigned studies. This role supervises clinical trial activities, the implementation of and adherence to study protocols, and oversees the schedules of assigned site...
-
Registered Nurse
3 weeks ago
Overland Park, Kansas, United States Intermountain Health Full timeJob Title: Registered Nurse - Park City GI ClinicWe are seeking a skilled and compassionate Registered Nurse to join our team at the Park City GI Clinic. As a Registered Nurse, you will play a vital role in providing high-quality patient care and contributing to the success of our healthcare team.Job Summary:The Registered Nurse will be responsible for...
-
Clinical Care Specialist
7 days ago
Overland Park, Kansas, United States Curana Health Full timeJob SummaryThe Clinical Care Specialist will administer direct patient care services within the Post-Acute Care setting. This role requires a strong clinical background and excellent communication skills to effectively coordinate care with collaborating physicians and other disciplines.Key Responsibilities Conduct clinical interventional and episodic direct...
-
Clinical Nurse Specialist
2 weeks ago
Overland Park, Kansas, United States The University of Kansas Health System Full timeJob Title: Clinical NurseAt The University of Kansas Health System, we are seeking a skilled Clinical Nurse to join our team. As a Clinical Nurse, you will play a vital role in delivering high-quality patient care and ensuring the well-being of our patients.Job Summary:The Clinical Nurse will be responsible for providing comprehensive care to patients with...
-
Clinical Nurse Specialist
3 weeks ago
Overland Park, Kansas, United States The University of Kansas Health System Full timeJob Title: Clinical NurseWe are seeking a skilled Clinical Nurse to join our team at The University of Kansas Health System. As a Clinical Nurse, you will play a vital role in delivering high-quality patient care in a behavioral health setting.Key Responsibilities:Provide thorough and timely documentation of patient data, therapeutic interventions, and...
-
Clinical Research Nurse
4 weeks ago
Overland Park, Kansas, United States Altasciences Full timeAbout the RoleThe Clinical Research Nurse will be responsible for ensuring the safety and well-being of clinical trial participants during study conduct and the maintenance of safety equipment.The successful candidate will execute tasks performed in compliance with study protocol, Good Clinical Practices (GCP) and Standard Operating Procedures (SOPs).Key...
-
Clinical Research Nurse
3 weeks ago
Overland Park, Kansas, United States Altasciences Full timeAbout the RoleThe Clinical Research Nurse will be responsible for ensuring the safety and well-being of clinical trial participants during study conduct and maintaining safety equipment.This role will involve executing tasks in compliance with study protocol, Good Clinical Practices (GCP), and Standard Operating Procedures (SOPs).Key ResponsibilitiesPerform...
-
Travel Nurse
4 weeks ago
Overland Park, Kansas, United States Travel Nurse Source Full timeAbout the PositionTravel Nurse Source is partnering with Magnet Medical to find a skilled Med/Surg RN for a rewarding opportunity in Goodland, Kansas.Job SummaryWe are seeking a dedicated and compassionate Registered Nurse to provide high-quality patient care in a dynamic medical-surgical setting. As a Travel Nurse, you will have the opportunity to work with...
-
Clinical Call Center Nurse
1 week ago
Overland Park, Kansas, United States AssistRx Full timeJob Title: Clinical Call Center NurseThe Clinical Call Center Nurse is a critical role at AssistRx, providing clinical call center services to patients. This position requires a strong understanding of clinical procedures and excellent communication skills.Provide education and support to patients on product use and self-injection techniques.Collaborate with...
-
Clinical Call Center Nurse
2 weeks ago
Overland Park, Kansas, United States AssistRx Full timeJob Title: Clinical Call Center Registered NurseThe Clinical Call Center Registered Nurse is a vital role at AssistRx, where we revolutionize healthcare by improving patient access to essential medications. As a Clinical Call Center Registered Nurse, you will provide and document clinical call center services for patients, ensuring they receive the best...
-
Clinical Call Center Nurse
4 weeks ago
Overland Park, Kansas, United States AssistRx Full timeJob SummaryThe Clinical Call Center Registered Nurse is a key member of our team, providing clinical support and education to patients through our call center. This role requires a strong nursing background, excellent communication skills, and the ability to work in a fast-paced environment.Key ResponsibilitiesProvide clinical support and education to...
-
Clinical Nurse Specialist
1 week ago
Overland Park, Kansas, United States The University of Kansas Health System Full timeJob SummaryThe Clinical Nurse ensures that all clinical care is delivered in a manner that meets or exceeds goals and expectations for clinical outcomes, quality assurance standards, and patient satisfaction.The RN gauges the behavioral health patients' psychiatric state, collaborates with a multi-disciplinary team to support each patients' care plan,...
-
Clinical Nurse Specialist
4 weeks ago
Overland Park, Kansas, United States College Park Family Care Full timeJoin Our Team as a Licensed Practical NurseWe are seeking a skilled Licensed Practical Nurse to join our team at College Park Family Care. As a member of our healthcare team, you will play a vital role in providing high-quality patient care and contributing to the success of our practice.About the RoleThis is a fantastic opportunity for a dedicated and...
-
Clinical Nurse Specialist
4 weeks ago
Overland Park, Kansas, United States College Park Family Care Full timeJoin Our Team as a Licensed Practical NurseWe are seeking a skilled Licensed Practical Nurse to join our team at College Park Family Care. As a member of our healthcare team, you will play a vital role in providing high-quality patient care and contributing to the success of our practice.About the RoleThis is a fantastic opportunity for a dedicated and...
-
Clinical Call Center Nurse
4 weeks ago
Overland Park, Kansas, United States AssistRx Full timeJob SummaryThe Clinical Call Center Nurse will provide clinical support to patients through inbound and outbound calls, ensuring timely and effective communication of product information and self-injection techniques. This role requires strong nursing skills, excellent communication, and a patient-centric approach.Key ResponsibilitiesProvide education and...
Clinical Utilization Review Nurse
2 months ago
The Clinical Utilization Review Nurse is responsible for conducting both prospective and retrospective evaluations of post-acute care services. The primary objective of utilization management is to ensure that WellSky's patient population receives necessary medical services in the right environment, with the right provider, and at the right level of care.
This role involves the prompt assessment of requests for post-acute services, utilizing established clinical guidelines and coverage benefit limitations to determine the appropriateness of the requested services.
Key Responsibilities:- Conduct initial prior authorization reviews of post-acute care services, applying guideline criteria for approval and escalating to Medical Directors when necessary for adverse determinations.
- Authorize post-acute care services in accordance with contractual agreements, health plan guidelines, and medical necessity criteria.
- Leverage knowledge of healthcare system resources to effectively assist physicians and patients.
- Complete Interrater Reliability Testing to ensure consistent application of review criteria.
- Make benefit determinations regarding appropriate levels of care based on clinical guidelines.
- Facilitate benefits coordination and transitions across various care settings.
- Consult with Medical Directors for complex cases as required.
- Utilize clinical expertise in discussions with internal and external Case Managers and Physicians.
- Adhere to all Standard Operating Procedures throughout the case management process.
- Gather clinical information to assess and expedite reviews as necessary.
- Participate in team meetings, educational discussions, and related activities.
- Maintain compliance with Federal, State, and accreditation standards.
- Identify opportunities for enhancing communication and processes.
- Engage in various special projects and undertake additional duties as assigned.
Required:
Active RN license and a minimum of 5 years of clinical nursing experience.
Preferred:
RN Compact License, experience in utilization review, case management, or managed care, familiarity with MCG/Interqual or other criteria-based applications, and a general understanding of managed care guidelines.
Graduation from an accredited nursing program is essential, along with 1-2 years of experience in utilization management or related fields. Candidates must be able to pass federal and state-required criminal/abuse background checks and drug screenings. Proficiency in computer skills, including MS Office and clinical/operational software, is also required.
Additional Expectations:- Willingness to work additional or irregular hours as needed.
- Adherence to corporate and organizational security policies and procedures.
- Flexibility to perform other responsibilities as assigned.
At WellSky, we foster an environment where independent thinking and collaboration thrive, creating a culture that values innovation and inclusiveness. We are committed to making a difference in the healthcare landscape.
WellSky is an equal opportunity employer, providing opportunities to all individuals without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other characteristic protected by law.
We are proud to maintain a drug-free workplace.
Applicants for U.S.-based positions must be legally authorized to work in the United States, and verification of employment eligibility will be required at the time of hire.
Full-time teammates at WellSky are eligible for a range of exciting benefits, including:
- Comprehensive medical, dental, and vision coverage.
- Mental health benefits through TelaDoc.
- Prescription drug coverage.
- Generous paid time off, plus 13 paid holidays.
- Paid parental leave.
- 100% vested 401(K) retirement plans.
- Educational assistance up to $2500 per year.
