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

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 Outpatient Surgery at CommonSpirit Health is responsible for providing nursing care according to the nursing process, including assessment, diagnosis, planning, implementing, and evaluating. This role involves implementing appropriate nursing care interventions, administering medications and treatments in accordance with physician orders and established nursing policies and procedures, and delivering care based on defined standards of patient care and nursing evidence-based practice.

RN Outpatient Surgery

Registered Nurse Outpatient Surgery

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 Registered Nurse in the Medical/Surgical unit at LifePoint Health's Central Kentucky market is responsible for performing plan of care interventions, including medication administration, specimen collection, clinical treatments, and other medical care treatment. This role involves documenting patient care, monitoring and communicating patient conditions, assisting patients with activities of daily living, and coordinating patient care across disciplines. The position offers competitive pay, paid time off, extended illness benefits, flexible spending accounts, choice of insurance plans, educational assistance, bereavement leave, 401(k) match, and free parking.

Med/Surg RN, Part-Time

Registered Nurse - Medical/Surgical

The Clinical Triage Nurse at Sutter Health aids patients in obtaining the correct level of care with the appropriate provider at the right time. This role involves providing advance clinical telephone support to patients, other callers, in-basket and other remote support for physicians, and limited in-clinic support. The nurse uses the nursing process, input from physicians, and Sutter Health's approved telephone nursing guidelines and protocols to maintain highly efficient operations, provide quality care, and ensure positive patient outcomes. Responsibilities include assessing patients' needs, appropriately disposing of cases, collaborating with clinic and hospital-based providers, and performing nursing follow-up activities.

Clinical Triage Nurse - Work From Home

Clinical Triage Nurse

The Payment Integrity RN at Cambia Health Solutions, Inc. is responsible for conducting post-service review of claims in prepayment, post-payment, or audit capacity to ensure appropriate clinical review, reimbursement of claims, and accuracy of coding. This role involves applying internal medical and reimbursement policies, as well as correct coding guidelines based on national standards, all in service of making members' health journeys easier. The position offers the opportunity to work from home within Oregon, Washington, Idaho, or Utah.

Payment Integrity RN

Payment Integrity Registered Nurse

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

LHC Group is seeking a Registered Nurse for a Home Health position in Mount Vernon, Kentucky. This role offers flexibility for work-life balance, opportunities for career growth, the ability to build trusted nurse-patient relationships, and employee-focused wellness and support programs. The RN will provide and direct nursing care to patients in their homes as prescribed by the physician, coordinate the total plan of care, and ensure patients meet home health eligibility and medical necessity guidelines.

staff - Registered Nurse (RN) - Home Health - $81K+ per year

Registered Nurse - Home Health

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

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

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

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]

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

Skyline Med Staff Home Health is seeking a travel nurse RN specializing in Home Health for a travel nursing job in Richmond, Kentucky. The role involves working 40 hours per week on 8-hour day shifts. This position is designed for those looking to travel and work in different locations, offering a unique opportunity to explore new places while maintaining a professional career.

Travel Nurse RN - Home Health - $2,096 per week

Travel Nurse RN - Home Health

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Registered Nurse Jobs in Richmond, KY Hiring Now

Registered Nurse RN - Utilization Review PRN