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3.6Commonwealth Care Alliance – Boston, MA11 days ago 11dorganizational determinations. The Utilization Management ReviewNurse reports to the Utilization Management Nurse Manager. Key Responsibilities… The Utilization Management (UM) ReviewNurse is responsible for day-to-day timely clinical and service authorization review for…![MemorialCare Health System Logo]()
3.2MemorialCare Health System – Fountain Valley, CA26 days ago 26dCalifornia Registered Nurse (RN) preferred. Licensed Vocational Nurse (LVN) with consideration made based on utilization management and… complex clinical, benefit and network decisions. Apply UtilizationReview Management process to ensure continuity of care throughout…![Blue Cross and Blue Shield of Texas Logo]()
3.1Blue Cross and Blue Shield of Texas – Richardson, TXEst. Salary $78k-$99kHelp us improve this Salary Range
8 days ago 8dmembers, providers and facilities. JOB REQUIREMENTS: *Registered Nurse (RN) with valid, current, unrestricted license in the state… identifies and reports cases, and provides information regarding utilization management requirements and operational procedures to members…![ViziRecruiter Logo]()
4.5ViziRecruiter – Detroit, MI20 days ago 20da Healthcare Company and they are searching for a UtilizationReviewNurse To learn more, please click on the 'apply on company… company website' button above. Keywords: Healthcare, Medical, Nursing, Patient Care…![Adventist Health System Logo]()
3.8Adventist Health System – Tampa, FLEst. Salary $51k-$64kHelp us improve this Salary Range
30+ days ago 30d+RNs and under the general direction of the Director of UtilizationReview, with oversight of authorization support staff workflows… Minimum five (5) years acute clinical nursing experience Active Florida Registered Nursing license Commercial or managed care…![MedStar Washington Hospital Center Logo]()
3.5Washington Hospital Center – Washington, DCNEWAppeals assists in the administration of utilization functions, the UtilizationReviewNurse, assesses patient insurance/status to… to facilitate appropriate completion of utilizationreview using payer specific criteria; uses Interqual and MCG to determine medical…![Carilion Clinic Logo]()
3.3Carilion Clinic – Atlanta, GAEst. Salary $46k-$59kHelp us improve this Salary Range
10 days ago 10dpractice model · Extensive nursing research funding and continued education support · A year-long nurse residency program for new… Registered Nurse in Virginia or eligible to obtain Virginia RN licensure. · Graduate of school of professional nursing of an accredited…![Oscar Insurance Logo]()
3.6Oscar Insurance – Los Angeles, CA10 days ago 10dUtilizationReviewNurse At Oscar, we work hard to provide the kind of health insurance we would want for ourselves. This means… appropriate care in a timely, transparent way. As a UtilizationReviewNurse, you will determine the medical appropriateness of…![WellCare Logo]()
3.3WellCare – Tampa, FL17 days ago 17dskilled nursing facility reviews Preferred- Strong preference for previous experience in utilizationreview/utilization management… Education: Required A High School or GED Utilizationreviewnurseutilization management managed care health integrated Humana…- KORAK – Washington, DCNEWinappropriate utilization of resources to the Chief Medical Officer; identifies and reports quality and or utilization issues to the… the Chief Medical Officer. Reviews health plan, appeal items for concurrent and retrospective reviews as required and requested…
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4.4Central California Alliance for Health – Merced, CAEst. Salary $67k-$135kHelp us improve this Salary Range
7 days ago 7dwhich include UM Concurrent Review and SNF Programs; Performs duties as a UM Concurrent ReviewNurse, as needed; Assists UM Manager… Concurrent ReviewNurse, as needed, with duties including but not limited to: Providing UM Concurrent Review coverage in…![Rising Medical Solutions Logo]()
3.5Rising Medical Solutions – Chicago, ILEASY APPLY5 days ago 5dSolutions has an opening for an UtilizationReviewNurse, and we want to hear from you! We're a bill review and cost containment company… cost of healthcare claims through bill review, case management, and utilizationreview. Our mission is "To protect the health…![Carolinas HealthCare System Logo]()
3.5Carolinas HealthCare System – Concord, NC4 days ago 4dadmission and concurrent reviews. Applies clinical guidelines during Admission and Concurrent reviews and identifies potential… and Certifications Graduation from an accredited School of Nursing. NC RN licensure required. Related experience preferred. Basic…![WellCare Logo]()
3.3WellCare – Phoenix, AZ21 days ago 21dLPN licensed Experience: Minimum of 1 year of general nursing experience. Managed care experience preferred. Licenses… completion of ER PLP reconsiderations from receipt to adjudication. Utilizes clinical knowledge to evaluate and assess the clinical necessity…![ViziRecruiter Logo]()
4.5ViziRecruiter – Detroit, MI19 days ago 19dclient, Trusted Health Plan is looking to fill an open UtilizationReviewNurse position. To learn more about this position, please…![Integrated Resources Logo]()
4.1Integrated Resources – Edison, NJEst. Salary $58k-$91kHelp us improve this Salary Range
11 days ago 11dReviewing medical information and making a recommendation to the medical director regarding admission to an inpatient hospital…![Quantum Health Logo]()
3.5Quantum Health – Columbus, OH25 days ago 25dJob Title: Utilization Management Nurse (LPN) Working Group: Clinical Operations Reports to: Pod Manager Quantum Health… join our winning culture! We are looking for an LPN Utilization Management Nurse. Roles and Tasks: Promote the mission…![Alvarez & Marsal Logo]()
3.7Alvarez & Marsal – New York, NYNEWcare. Senior Associate-UtilizationReviewNurse Consultant: The Senior UtilizationReviewNurse Consultant is responsible… Associate- utilizationreviewnurses responsibilities include, but are not limited to: Care Facilitation, Utilization Management…![Santa Barbara Cottage Hospital Logo]()
3.5Santa Barbara Cottage Hospital – Santa Barbara, CA26 days ago 26d- CA Registered Nurse The UtilizationReviewNurse is responsible for utilizationreview, utilization management, and quality… relevant stakeholders with regard to utilizationreview management. The UtilizationReviewNurse will work collaboratively and…![Presbyterian Healthcare Services Logo]()
3.5Presbyterian Healthcare Services – Albuquerque, NMEst. Salary $58k-$74kHelp us improve this Salary Range
18 days ago 18dCredentials: Registered Nurse - State of New Mexico or Compact State Nursing License or Graduate Nurse Permit required. BLS certification… Associate Degree in Nursing (BSN completion within 5 years of hire) Degree from accredited academic nursing program (If a program…![Cleveland Clinic Logo]()
3.8Cleveland Clinic – Independence, OH26 days ago 26dEducation: Associate's degree in Nursing (Licensed Practical Nurse, Registered Nurse) or Health Information Technology.… Current state licensure as a Licensed Practical Nurse (LPN) or Registered Nurse (RN). Complexity of Work: Requires critical…![Advanced Resources Logo]()
3.9Advanced Resources (IL) – Maywood, IL12 days ago 12dlooking for a UtilizationReview Registered Nurse with Interqual, EPIC and AllScripts experience. The UtilizationReview RN will be… AllScripts Experience with UtilizationReview in an inpatient setting 2-5 years of UtilizationReview experience RN Required…![Quantum Health Logo]()
3.5Quantum Health – Columbus, OHEst. Salary $61k-$77kHelp us improve this Salary Range
25 days ago 25dJob Title: Utilization Management Nurse (RN) Working Group: Clinical Services Reports to: POD Manager Quantum… to join our winning culture! We are looking for a Utilization Management Nurse. Roles and Tasks: Promote the mission…![Cencal Health Logo]()
4.6Cencal Health – Santa Barbara, CAEst. Salary $52k-$70kHelp us improve this Salary Range
11 days ago 11dwork environment) The UM Nurse performs prospective, concurrent, and retrospective reviews for long- term care, acute inpatient… acute care, subacute, skilled nursing, and long-term care setting Perform timely retrospective review for services that required…![Harvard Pilgrim Logo]()
3.7Harvard Pilgrim Health Care – Quincy, MA4 days ago 4dAssociate UtilizationReviewNurse is responsible for the administration of Harvard Pilgrim’s pre-admission review process for… physician review and complete determinations following physician review. This individual will perform duties to support review of requested…![Integrated Resources Logo]()
4.1Integrated Resources, Inc. – Denver, CO5 days ago 5dTitle: UtilizationReviewNurse Location : Denver CO 80204 Duration : 3+ Months Contract with extension Details: Under… additional review by the Plans Medical Director. MINIMUM QUALIFICATIONS: Education: Bachelors degree in Nursing. A combination…![The Judge Group Logo]()
3.2The Judge Group, Inc. – Marlton, NJ5 days ago 5d539447 Judge Healthcare is currently seeking a UtilizationReviewNurse for our best client in Marlton, NJ This job will… an experienced RNs to work on a pilot for centralized UtilizationReview Must have UR experience Recent hospital /acute care…![Medix Logo]()
3.4Medix – Boston, MA11 days ago 11didentified variances or specific members according to criteria utilized for appropriate level of care. Identifies opportunities for… so please feel free to apply! Job Responsibilities: Reviews inpatient admissions, continued stays, specialty referrals…![Central California Alliance for Health Logo]()
4.4Central California Alliance for Health – Scotts Valley, CAEst. Salary $82k-$101kHelp us improve this Salary Range
4 days ago 4dskilled-nursing and long-term care facilities to perform concurrent and/or retrospective review; Knowledge of Utilization Management… confidentiality of utilizationreview, quality management information and beneficiary identification; and Attending Concurrent Review Rounds…![Unimed Direct Logo]()
3.0UniMed Direct – Richardson, TXNEWrush hour? We are looking for a RN with at least 2 years of nursing experience and knowledge of commercial evidence based guidelines…
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