The Case Management Utilization Review Registered Nurse at Steward Health Care is responsible for documenting medical necessity for inpatient status or placement in observation, communicating with physicians and clinicians, and ensuring timely clinical information is sent to payors for authorization. This role involves coordinating with allied health professionals to ensure quality care and outcomes, developing physician profiles for utilization patterns, and optimizing inpatient length of stay and resource utilization.

Case Management Utilization Review RN - REMOTE - Utilization Review

Case Management Utilization Review Registered Nurse

The Registered Nurse for PreCert and Appeals at ProMedica Health System performs prior authorization/certification of scheduled services with payers and assists with the appeal process when needed. This role involves clinical review and document submission for oncology treatments plans and services, interfacing with payers on plan medical coverage policies, and managing denial reports. The position is remote, ideally within 120 miles of Toledo, OH, and requires a nursing degree, 2 years of clinical experience, and familiarity with ICD10 and CPT codes.

RN / Registered Nurse - PreCert and Appeals - Remote - Per Diem - Days

Registered Nurse - PreCert and Appeals

Weatherby Healthcare is seeking a Nurse Practitioner specializing in Family Practice for a locum tenens position in Indianapolis, Indiana. The role involves telehealth services, requiring a minimum of 20 hours per week in 4-hour shifts, with 1-2 patients per hour aged 3 and older. This position offers competitive compensation, health, vision, dental, and 401(k) retirement benefits, paid malpractice insurance, and covers transportation and housing expenses.

LOCUM TENENS NURSE PRACTITIONER - FAMILY PRACTICE - $65-68 PER HOUR

Nurse Practitioner - Family Practice

IntellaTriage is seeking part-time Hospice Triage Registered Nurses to join their team, offering a remote work setting with a focus on end-of-life care. Nurses will provide compassionate care through nurse triage, utilizing high-speed internet and tech-savvy skills. The role involves working a minimum of one evening shift weekly, every other weekend, and may include additional shifts as needed. Training is provided remotely, and nurses will use their own laptop and high-speed internet for work.

Remote Hospice Triage RN- PT 1 shift 6p-12a+ rotating Sat & Sun

Hospice Triage Registered Nurse

Maxim Healthcare in Peoria, IL is seeking a Registered Nurse for a patient in Grand Ridge, IL. The role involves providing and documenting skilled nursing care in accordance with the care plan and physician's orders, under the supervision of a clinical designee. This position offers a $2,000 sign-on bonus and requires adherence to Maxim's philosophy, standards, and policies.

RN - Homecare - Grand Ridge

Registered Nurse - Homecare

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

AmeriHealth Caritas is seeking a Care Manager II Registered Nurse for their Foster Care Program in South Carolina. This remote position requires a BSN and an unrestricted RN license in South Carolina or a compact state. The role involves engaging directly with members through face-to-face visits in the community, monitoring and updating care plans, and collaborating with healthcare professionals to ensure members receive comprehensive care. The ideal candidate will have experience in pediatric home care or acute care, and preferably in the Foster Care System, Department of Social Services, or Department of Juvenile Justice.

REMOTE | CARE MANAGER II REGISTERED NURSE (BSN) - FOSTER CARE PROGRAM -SC

Care Manager II Registered Nurse

The Licensed Practical Nurse (LPN/LVN) is responsible for providing and documenting skilled nursing care under the supervision of a Registered Nurse, in accordance with the developed care plan and physicians orders for each individual patient. This role involves adhering to confidentiality standards and professional boundaries, delivering and coordinating quality patient care, and educating patients and families on self-care techniques and prevention strategies.

Licensed Practical Nurse (LPN/LVN)

Licensed Practical 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

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 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

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 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.

Utilization Review Nurse

The Clinical Nurse Educator at Amgen is a field-based position responsible for supporting patients prescribed ACTIMMUNE. This role involves providing logistical and educational assistance to patients, caregivers, and office staff, including physicians, nurses, and social workers. The CNE will work closely with patients and families, as well as healthcare professionals, to address barriers to patient medication access and improve adherence. The role requires collaboration with numerous internal teams to offer education and resources on insurance processes and treatment access.

Clinical Nurse Educator (Rare Disease)

Clinical Nurse Educator

Adelphi Medical Staffing is seeking an autonomous Psychiatric Nurse Practitioner (PMHNP) to provide virtual psychiatric services to adolescents and children, and conduct primary care screenings at multiple clinics in Petersburg, Virginia. This contract position involves a telehealth shift schedule of one day per week, offering an opportunity to contribute to global health initiatives, embrace lifelong learning, increase earnings, and learn from seasoned professionals.

NURSE PRACTITIONER (NP) - PSYCHIATRY IN PETERSBURG, VA - EXCELLENT BENEFITS 2024-07-14

Psychiatric Nurse Practitioner

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