The Case Management Utilization Review Registered Nurse at Steward Health Care assumes primary responsibility for documenting medical necessity for inpatient status or placement in observation. This role involves communicating with physicians and clinicians, ensuring timely clinical information submission for payor authorization, and collaborating with allied health professionals to ensure quality care and desired outcomes in a cost-effective manner. The position requires a bachelor's degree, three to five years of acute medical/surgical experience, and three to five years of Case Management experience.

Case Mgt Utilization Review RN - REMOTE - Utilization Review

Case Management Utilization Review Registered Nurse

Trusted Resource Associates (TRA) is seeking a local contract nurse RN specializing in Utilization Review for a 13-week contract job in Modesto, California. The role involves facilitating care along a continuum through effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources. This position requires managing the medical necessity process for accurate and timely payment for services, which may involve negotiation with payers on a case-by-case basis.

Local Contract Nurse RN - Utilization Review - $84 per hour

Contract Nurse RN - Utilization Review

As a Utilization Review RN at Ascension Seton Northwest, you will provide healthcare services related to admissions, case management, discharge planning, and utilization review. This role involves reviewing admissions and service requests for medical necessity and compliance with reimbursement policy criteria, providing case management and consultation for complex cases, assisting with coding, medical records, precertification, reimbursement, and claim denials/appeals, and overseeing compliance to utilization management rules and regulations.

Utilization Review RN - Utilization Review

Utilization Review RN

The Registered Nurse - Utilization Review at Ascension St. Vincent's Birmingham is responsible for providing health care services regarding admissions, case management, discharge planning, and utilization review. This role involves reviewing admissions and service requests for medical necessity, providing case management for complex cases, assisting staff with coding, documentation, and reimbursement issues, and overseeing compliance with utilization management rules. The position requires at least 3 years of acute care experience and utilization management experience.

Registered Nurse RN - Utilization Review  PRN

Registered Nurse - Utilization Review

Trusted Resource Associates (TRA) is seeking a local contract nurse RN Utilization Review for a local contract nursing job in Modesto, California. The RN Case Manager is responsible for facilitating care along a continuum through effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources. This position involves managing the medical necessity process for accurate and timely payment for services, which may require negotiation with a payer on a case-by-case basis.

LOCAL CONTRACT NURSE RN - UTILIZATION REVIEW - $84 PER HOUR

Utilization Review Nurse

The Registered Nurse Case/Utilization Manager is responsible for patient case management, including longitudinal engagement, coordination for discharge planning, transition of care needs, and outpatient patient management through the care continuum. This role involves identifying, screening, tracking, monitoring, and coordinating the care of patients with multiple co-morbidities and/or psychosocial needs, developing action plans or discharge plans, and providing continuity of care in collaboration with the hospital/physician team and ambulatory care team. The position offers the flexibility to work remotely from anywhere within the U.S.

Registered Nurse Case/Utilization Manager Compact License - Case Management

Registered Nurse Case/Utilization Manager

Pine Park Health is seeking a Registered Nurse to join their team, focusing on providing primary care to residents of senior living communities. The role involves collaborating with a multidisciplinary team, triaging communications, supporting care team members, engaging in comprehensive chart preparation, overseeing post-appointment processes, conducting virtual patient assessments, and participating in quality improvement initiatives. The ideal candidate will have at least 2 years of clinical experience, preferably in geriatrics, and strong experience in remote roles.

Registered Nurse - Remote - Med Surg

Registered Nurse - Med Surg

The Utilization Management Nurse Reviewer (RN) serves as the Subject Matter Expert for patient admission status (inpatient and observation) at Wooster Community Hospital. This role involves working with Providers, Case Management, and the Revenue Cycle team to ensure appropriate admission status, protecting the financial interests of the organization by ensuring the UM review cycle is successfully completed, and tracking and trending payer issues. The position is remote but must be within a 4-hour drive of the hospital.

Utilization Management Nurse Reviewer - FT

Utilization Management Nurse Reviewer

The Registered Nurse - Review Analyst at W3R Consulting will perform prospective, concurrent, and retrospective review of inpatient, outpatient, ambulatory, and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service, and level of care, including appeal requests initiated by providers, facilities, and members. This role may also involve establishing care plans and coordinating care through the healthcare continuum, including member outreach assessments.

Registered Nurse

Registered Nurse - Review Analyst

The Licensed Utilization Review I (RN) at Elevance Health is responsible for working with healthcare providers to ensure appropriate and consistent administration of plan benefits through clinical information collection, preauthorization of services, and applying medical policies and clinical guidelines within their scope of licensure. This remote position requires the candidate to reside in Florida and involves conducting pre-certification, retrospective reviews, and facilitating care coordination. The role also focuses on developing relationships with physicians and healthcare providers to improve health outcomes for members.

Licensed Utilization Review I (RN)

The Medical Claims Reviewer - RN at TriWest Healthcare conducts retrospective review of behavioral health or medical/surgical claims for inpatient and outpatient services to establish medical necessity, benefit coverage, appropriateness of quality of care, and/or length of stay or care plan. This role involves applying clinical, coding, and processing knowledge to conduct reviews and process claims, compiling and reviewing clinical information, and ensuring adherence to program benefits. The position offers remote work opportunities in specific states and encourages applications from veterans, reservists, guardsmen, military family members, and U.S. citizens.

Medical Claims Reviewer - RN

As a Utilization Management Nurse Consultant at CVS Health, you will utilize clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. This role involves ensuring members receive appropriate care at the right time and location, adhering to federal and state regulations, and facilitating safe and efficient discharge planning. The position is fully remote with specific work hours and requires availability for weekend and holiday rotations.

Utilization Management Nurse Consultant

Pyramid Consulting, Inc. is seeking a talented Registered Nurse/Consultant Training for a 12+ months contract opportunity in Austin, TX, with long-term potential. The role involves facilitating a library of 33 virtual instructor-led medical webinars for CE credit, updating webinar material, and acting as a resource for trainers and specialists. This position requires advanced-level technical training and serves as the highest level technical professional within the organization.

Registered Nurse/ Consultant Training

Registered Nurse/Consultant Training

A large healthcare insurance company local to the Philadelphia area is seeking a fully remote Case Management RN to join their Care management team. The role involves telephonic or onsite review of hospital admissions, determining alternative settings when appropriate, promoting efficient and high-quality use of the healthcare delivery system, and facilitating timely and dynamic discharge planning. The RN will collaborate with the hospital utilization review department, attending physicians, and members/families as appropriate.

Utilization Management RN - REMOTE (PA, NJ, DE)

Utilization Management Registered Nurse

The Licensed Utilization Review LD (RN) at Elevance Health is responsible for collaborating with healthcare providers to ensure appropriate and consistent administration of plan benefits through preauthorization services, assessing medical necessity, out-of-network services, and appropriateness of treatment setting. This role involves applying medical policies, clinical guidelines, and plan benefits within the scope of licensure, developing partnerships with healthcare service providers, and educating members about plan benefits.

Licensed Utilization Review Ld (RN)

Licensed Utilization Review LD (RN)

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Contract Nurse RN - Utilization Review Jobs in San Martin, CA Hiring Now