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 - 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 Registered Nurse for the Minimum Data Set at Ascension Living is responsible for collecting data for use in determining care plans, ensuring the accuracy of patient charts and medical data, and participating in the CMS survey process. This role is part of an interdisciplinary team and requires current knowledge of federal, state, and local standards and regulations for long-term care. The position is remote and offers a variety of benefits, including paid time off, health insurance options, retirement benefits, and more.

RN-Minimum Data Set

Registered Nurse - Minimum Data Set

Two immediate vacancies for dedicated registered nurses in Irving, Texas, working remotely. The role involves using Axxess software for home health care, including start of care, revisits, and discharges. The nurse will collaborate with other healthcare professionals to ensure comprehensive patient care.

Remote Home Health Nurse

Remote Licensed Registered Nurse for Home Care

The Triage Nurse (RN) at CenterWell is responsible for assessing patients' health problems and needs, developing and executing nursing care plans, and assisting in maintenance of patient medical records. This role involves varied work assignments that require interpretation and independent determination of appropriate courses of action. The position is remote and telephonic, focusing on evaluation of patients with ambulatory diagnoses as well as possible acute conditions and medication refills, in partnership with the center's mid-levels and PCPs.

Triage Nurse - CenterWell - Eastside

Triage Nurse

The Utilization Review Nurse is responsible for the review of precertification admission and concurrent reviews for the appropriateness of the inpatient setting utilizing InterQual criteria. This role involves entering or referencing data via PC, collaborating with facilities, providers, and Medical Directors, and requires excellent written and oral communication skills. The position is remote, with a work location in Detroit, MI, and is a 10-month contract job type.

UC Health is seeking a Registered Nurse (RN) for Denials/Charge Audits in the Perioperative department. This remote position involves supporting data analysis, data mining, and quality monitoring to improve quality of care, service levels, revenue realization, and cost effectiveness. The role offers a work-from-home schedule and a culture that values success and growth.

Registered Nurse (RN), Denials/Charge Audits, Perioperative, First Shift

Registered Nurse, Denials/Charge Audits

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

We are seeking a Registered Nurse Coder to join our team in the healthcare industry, working remotely with EST hours. This role involves working on a COC/SPD project to build out the coding for our benefit plans, utilizing clinical knowledge and coding skills to support project deliverables. The position offers an opportunity to work in a thriving sector and contribute to the team's objectives.

Registered Nurse Coder

Sequence Health is seeking a part-time Triage Nurse to provide nursing and administrative support to a range of practices across the country. The role involves receiving and making inbound calls from patients, providing clinical assessments and triage based on established protocols, and offering administrative support for patients' and providers' needs. The ideal candidate will have strong computer and phone skills, excellent communication abilities, and the ability to work independently.

Triage Nurse (Telehealth) [Part-Time]

Sentara Obici Hospital in Suffolk, Virginia is seeking a Registered Nurse Traveler for their 37 bed Emergency Room Unit, including a dedicated 5-bed Behavioral Health Safe Suite. The role involves performing a competent level of nursing care through the nursing process, which includes assessment, diagnosis, outcomes identification, planning, implementation, coordination of care, teaching and health promotion, and evaluation. This position requires 2 years of recent Emergency Room hospital experience and a valid RN License.

RN Traveler Contract Emergency Dept $75/hr & Potential $5000 Sign on Bonus

Registered Nurse Traveler Emergency Department

The Digital Care RN at OSF HealthCare provides digital care to a diverse population of patients across OSF through technology across a variety of environments. This role involves comprehensive symptom assessment, patient education, preventative care, acute psychosocial support, and timely individualized age and developmentally appropriate care for patients. The RN utilizes critical thinking, evidenced-based care, and clinical decision support to guide practice, and performs ongoing communication to promote quality of care through collaboration with all care team members, patients, and families. This is a fully-remote position after training and orientation are complete.

RN Digital Triage

Digital Care Registered Nurse

PeaceHealth is seeking a Licensed Practical Nurse (LPN) for a remote clinic position. This full-time role involves implementing and evaluating patient care under the supervision of an RN or provider, obtaining and conveying information to and from patients, pharmacies, and other providers, and ensuring professional effectiveness through continued education. The position requires working from home with appropriate high-speed connectivity and offers a comprehensive benefits package.

LPN Clinic Remote

Licensed Practical Nurse Clinic

The Infusion Referral Nurse is responsible for performing referral services to support independent physician offices in maintaining member drug infusions in office or to help offices locate a lower cost alternative treatment site. This role involves discussing financial and clinical considerations with members, researching financial programs to decrease out-of-pocket expenses, and coordinating lower cost sites of service for drug administration if necessary. The position requires critical thinking to optimize treatment outcomes and maintain member satisfaction.

Infusion Referral Nurse- REMOTE

Infusion Referral Nurse

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Registered Nurse RN - Utilization Review PRN