Utilization Review Nurse
6 days ago
Vivo HealthStaff is seeking a skilled Utilization Review RN to join our team in San Francisco. This hybrid position requires 1-2 days of on-site work per week.
Job Summary:We are looking for a highly motivated and detail-oriented RN to collaborate with our healthcare team to ensure effective patient outcomes. The ideal candidate will have experience in acute care settings and possess strong communication and problem-solving skills.
Responsibilities:- Conduct concurrent and retrospective medical record reviews to determine medical necessity and ensure effective resource utilization.
- Collaborate with physicians, nurse case managers, and social workers to develop individualized patient plans.
- Communicate with third-party payers to obtain authorization and resolve denials.
- Identify and implement strategies to avoid denials and ensure timely payment for services.
- Provide education and support to healthcare team members on utilization review and management best practices.
- Valid RN license in the State of California.
- Bachelor's degree in Nursing.
- Clinical experience in acute care settings required.
- Experience with InterQual and Milliman preferred.
- CPR/BLS certification.
- CCM certification.
- ACMA certification.
Vivo HealthStaff is committed to providing a supportive and collaborative work environment. We offer competitive compensation and benefits packages, as well as opportunities for professional growth and development.
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Utilization Review Nurse
2 weeks ago
San Francisco, California, United States Vivo HealthStaff Full timeJob Title: Utilization Review RNVivo HealthStaff is seeking a skilled Utilization Review RN to join our team in San Francisco. This hybrid position requires 1-2 days of on-site work per week.Job SummaryWe are looking for a highly motivated and detail-oriented RN to collaborate with our healthcare team to ensure effective patient outcomes. The successful...
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San Francisco, California, United States Kaiser Permanente Full timeJob Summary:Kaiser Permanente is seeking a skilled Utilization Review Coordinator RN to join our team. As a key member of our healthcare team, you will be responsible for conducting utilization reviews for in-house patients and/or those members at contracted facilities. Your expertise will be essential in assisting with the discharge planning process and...
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San Francisco, California, United States Kaiser Permanente Full timeJob Summary:Kaiser Permanente is seeking a skilled Utilization Review Coordinator RN to join our team. As a key member of our healthcare team, you will be responsible for conducting utilization reviews for in-house patients and/or those members at contracted facilities. Your expertise will be essential in assisting with the discharge planning process and...
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San Francisco, California, United States Kaiser Permanente Full timeJob Summary:Kaiser Permanente is seeking a skilled Utilization Review Coordinator RN to join our team. As a key member of our healthcare team, you will be responsible for conducting utilization reviews for in-house patients and/or those members at contracted facilities. Your expertise will be essential in assisting with the discharge planning process and...
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Utilization Review Coordinator
5 days ago
San Jose, California, United States County of Santa Clara CA Full timeJob SummaryWe are seeking a highly skilled Utilization Review Coordinator to join our team at the County of Santa Clara CA. As a Utilization Review Coordinator, you will play a critical role in reviewing and monitoring the utilization of hospital services to ensure compliance with federal, state, and county regulations.Key ResponsibilitiesMonitor admissions...
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Case Management Nurse
4 weeks ago
San Mateo, California, United States County of San Mateo (CA) Full timeJob SummaryWe are seeking a highly skilled Case Management Nurse to join our team at the County of San Mateo Medical Center. As a Utilization Review Case Management Nurse, you will play a critical role in ensuring that patients receive the highest quality care while also optimizing resource utilization.Key ResponsibilitiesManage patient admission and ongoing...
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Utilization Review Nurse Specialist
3 weeks ago
San Luis Obispo, California, United States INFOSAGE SYSTEMS Full timeAbout the Job**Job Summary:**We are seeking a skilled Utilization Review Registered Nurse to join our team at Infosage Systems. As a Utilization Review RN, you will play a critical role in ensuring the quality and efficiency of patient care.Key Responsibilities:Monitor and report patient symptoms and changes in conditionAdminister non-intravenous medications...
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Clinical Utilization Review Nurse LVN
2 weeks ago
San Jose, California, United States Santa Clara County Health Plan Full timeJob SummaryWe are seeking a skilled Utilization Management Review Nurse LVN to join our team at Santa Clara County 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 ensure...
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RN Case Manager
1 week ago
San Francisco, California, United States HexaQuEST Health, Inc. Full timeJob Title: RN Case Manager - Utilization Review SpecialistWe are seeking a skilled RN Case Manager with strong utilization review experience to join our team at HexaQuEST Health, Inc.Job Summary:The successful candidate will conduct patient initial assessments, have acute care hospital experience, and be proficient in EPIC EMR documentation. Additionally,...
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Utilization Review Specialist
3 weeks ago
San Diego, California, United States Aurora San Diego Full timeJob SummaryAurora San Diego is seeking a skilled Utilization Review Specialist to join our team. As a Utilization Review Specialist, you will play a critical role in reviewing patient care and treatment options for both inpatient and outpatient services.Key ResponsibilitiesConduct admission reviews to ensure accurate and efficient patient care.Perform...
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Utilization Management Review Nurse LVN
6 days ago
San Jose, California, United States Santa Clara Family Health Plan Full timeJob 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 ensure...
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Travel Nurse RN
3 weeks ago
San Luis Obispo, California, United States HealthEcareers - Client Full timeMindlance Health is seeking a travel nurse RN Utilization Review for a travel nursing job.Job DetailsSpecialty: Utilization ReviewDiscipline: RNEmployment Type: TravelKey Responsibilities:Conduct thorough reviews of patient cases to ensure accurate and efficient use of healthcare resources.Collaborate with healthcare teams to develop and implement effective...
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Utilization Review Specialist
3 days ago
San Diego, California, United States Aurora San Diego Full timeJob SummaryAurora San Diego is seeking a skilled Utilization Review Specialist to join our team. As a key member of our multi-disciplinary treatment team, you will play a critical role in reviewing patient care and treatment options for both inpatient and outpatient services.Key Responsibilities:Conduct admission reviews to ensure accurate and efficient...
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Travel Nurse RN
3 weeks ago
San Luis Obispo, California, United States Mindlance Health Full timeMindlance Health is seeking a skilled travel nurse RN to fill a Utilization Review position in a dynamic healthcare setting.Job DetailsSpecialty: Utilization ReviewDiscipline: RNEmployment Type: TravelKey Responsibilities:Conduct thorough reviews of patient care to ensure optimal utilization of healthcare resources.Collaborate with healthcare teams to...
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Travel Nurse RN
3 weeks ago
San Luis Obispo, California, United States Mindlance Health Full timeJob Title: Travel Nurse RN - Utilization ReviewJob Summary:Mindlance Health is seeking a skilled Travel Nurse RN to fill a Utilization Review position in a dynamic healthcare setting. As a Travel Nurse RN, you will play a critical role in ensuring the efficient use of healthcare resources while maintaining high-quality patient care.Responsibilities:Conduct...
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San Diego, California, United States Healthcare Staffing Plus Full timeJob Title: Travel Registered Nurse Utilization ReviewWe are seeking a skilled Travel Registered Nurse Utilization Review professional to join our team at Healthcare Staffing Plus. As a Utilization Review Nurse, you will play a critical role in developing and maintaining policies and procedures for utilization management.Key Responsibilities:Collaborate with...
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San Diego, California, United States Healthcare Staffing Plus Full timeJob Title: Travel Registered Nurse Utilization ReviewJob Summary:We are seeking a skilled Travel Registered Nurse Utilization Review to join our team at Healthcare Staffing Plus. As a Utilization Review RN, you will play a critical role in developing and maintaining policies and procedures for utilization management. Your expertise will be utilized to...
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San Jose, California, United States Santa Clara County Health Plan Full timeJob SummaryWe are seeking a skilled Utilization Management Review Nurse LVN to join our team at Santa Clara County 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...
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San Diego, California, United States Healthcare Staffing Plus Full timeJob Title: Travel Registered Nurse Utilization ReviewWe are seeking a skilled Travel Registered Nurse to join our team in Utilization Review. As a key member of our healthcare team, you will be responsible for developing and maintaining policies and procedures related to Utilization Management.Responsibilities:Collaborate with multi-disciplinary teams to...
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Clinical Reviewer
2 weeks ago
San Francisco, California, United States MedRisk Full timeJob DescriptionMedRisk is seeking a skilled Clinical Reviewer to join our team in the utilization review program. This role is a collaborative process to promote quality outcomes, enhancing the physical, psychosocial, and vocational health of individuals.The Clinical Reviewer applies technical knowledge and experience to assess the medical necessity of...