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Utilization Review Nurse Jobs

Utilization Review Nurse Jobs
By Albany Medical Center At , New Scotland $65,062 - $107,349 a year

Thank you for your interest in Albany Medical Center!

Albany Medical is an equal opportunity employer.

Concurrent Review Nurse-( Auditor)- Metro, East, Northeast
By MMM Holdings At , San Juan
One to three years experience in utilization management or health services setting preferred.
Five years clinical acute care hospital experience; ICU, Emergency Medicine Department, Medical / Surgical Department.
Must have ability to work as a team player with excellent verbal and written communication skills.
Familiarity with State Federal Governmental regulations and national accrediting agency requirement preferred (CMS/NCQA or regulatory agencies).
Performs tasks requiring independent knowledge judgment in addition to instructions and procedures provided.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Rn Utilization Review Jobs
By Edward-Elmhurst Health At , Naperville, 60540
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
Minimum of two years of utilization review and/or clinical experience
Minimum of two years of utilization review experience
Associate’s Degree or higher in Nursing
Current State of Illinois Registered Nurse licensure
Bachelor’s Degree in Nursing or health care related field
Utilization Review/Performance Improvement Nurse*
By San Bernardino County At , $83,678 - $113,942 a year
An equivalent combination of education and experience may be considered.
Boost Annual Salary Up To: $118,102 When Modified Benefits Option Is Selected
Priority Review Will Begin on Monday, August 14, 2023 For Early Consideration
Receive Paid Holidays, Generous Vacation & Sick Time
Receive A County Pension To Plan For Retirement
For more detailed information, refer to the Utilization Review/Performance Improvement Nurse job description.
Utilization Review Nurse- Prn
By Netsmart Technologies At , Remote
At least 3 years case management, concurrent review or utilization management experience
Case management/concurrent review/utilization management experience within the ED setting
At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual.
Participate in telephonic discussions with emergency department physicians relative to documentation and admission status.
Enter clinical review information into system for transmission to insurance companies for authorization.
Utilization Review Case Manager
By Lehigh Valley Health Network At , Allentown, 18103
2 years Knowledge of utilization management as it relates to third party payers.
5 years of experience in case management and DC planning experience within the last 5 years.
Knowledge, Skills, and Abilities - Required:
Knowledge, Skills, and Abilities - Preferred:
2 years of previous utilization review experience. and
3 years of experience in acute care and
Senior Therapist - Youth Clinical Utilization Review
By City of Alexandria, VA At , Alexandria $66,460 - $89,027 a year
Implement Independent Assessment Certification & Coordination Team (IACCT) recommendations including locating residential treatment placements and intensive community based services;
Act as Family Assessment and Planning Team (FAPT) Case Manager for high needs youth and their families;
Engage families seeking residential services for their children in the Children’s Services Act (CSA) Parental Agreement process;
Provide consultation, coordination and monitoring when out-of-home behavioral health services are considered, including Parental Agreements;
Participate in multi-disciplinary planning meetings, court hearings, and relevant training, conferences and workshops;
Develop and monitor treatment plans with youth and their families based on their strengths, needs, preferences, and goals;
Behavioral Health Utilization Review Nurse- Hmhi
By University of Utah Health At , Salt Lake City, 84190, Ut
Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria.
One year Utilization Review or Case Management experience.
Knowledge / Skills / Abilities
Upload most recent updated resume with work history and experience, please include Month and Year in formatting.
Alerts and discusses with physician/provider and case manager/discharge planner when patient no longer meets medical necessity criteria for the inpatient stay.
Demonstrated team leadership, relationship building, critical analysis, and written and verbal communication skills.
Nurse Case Manager/Utilization Review Nurse I
By State of Vermont At , Burlington, Vt $38.58 - $60.51 an hour
Case management experience/certification, knowledge and experience with working with systems of healthcare, prior work in an Insurance Company setting is ideal.
Case management certification within 2 years is a goal for this position.
Starting rate may be negotiable based on experience and qualifications.
Clinical experience and knowledge, knowledge of community, and community culture are necessary.
Experience working with people with substance abuse/mental health and home visiting experience and knowledge of community is preferred.
Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
Medicaid Utilization Review Analyst
By State of Idaho Employment At Greater Idaho Falls, United States
An opportunity for student loan forgiveness (https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service)
an opportunity for student loan forgiveness (https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service)
THIS ANNOUNCEMENT WILL BE OPEN UNTIL FILLED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE TO BE CONSIDERED.
Generous vacation and sick leave accrual beginning as soon as you start
11 paid holidays a year
Multiple savings plans, optional 401K, and optional 457
Utilization Review Licensed Vocational Nurse (Lvn) – Utilization Management- Remote
By Kelsey-Seybold Clinic At , Pearland, Tx $54,186 - $66,936 a year
Job Title: Utilization Review Licensed Vocational Nurse (LVN) – Utilization Management
Required: Licensed Vocational Nurse, CEU requirement.
Preferred: Computer and Coding experience.
Required: Good organization and communication skills
Required: HMO, PPO and POS insurance knowledge
Employee Reward and Recognition Program
Utilization Review Nurse Jobs
By Ethos At Austin, TX, United States
Certified Case Manager (CCM), Health Care Quality & Management (HCQM) or equivalent certification preferred.
1-year experience with workers' compensation/utilization management preferred.
Assists in promoting and furthering the objectives of the Quality Management Program.
Active, unrestricted professional license or certification to practice as a health professional in a state or territory of the United States:
2 years of clinical nursing experience (direct patient care, administrative or combination post licensure).
Knowledge of workers' compensation laws and regulations (preferred).
Utilization Review Nurse - Remote | Wfh
By Get It Recruit - Healthcare At Atlanta, GA, United States

Are you ready to make a significant impact on healthcare quality, cost efficiency, and patient well-being? Join our dynamic team as a Utilization Management Nurse and play a pivotal role in ensuring ...

Utilization Review Nurse Hospital Compliance, Hybrid
By University of Maryland Medical System At , Linthicum, Md
Drafts written reports that detail audit findings and recommendations to senior UMMS leadership, Department management/personnel, and/or other related business partners.
Provides input to CCBEG management and operational leaders to assist in the creation of management action plans to resolve identified deficiencies.
In collaboration with CCBEG management, performs activities specified in the Auditing and Monitoring Plan.
This position requires experience with utilization review in a hospital setting.
Conducts analysis of findings to identify trends/problems in billing and documentation.
Develops and administers coding and billing compliance training related to audit findings.
Utilization Review Nurse Pchp-(Ft/Days)
By Centra Health At , , Va

Be yourself. Be a partner with Centra.

Concurrent Nurse Reviewer, Facility Utilization Review Unit
By Hawaii Medical Service Association At , Honolulu, 96814, Hi
Two years clinical care experience or case management or related experience.
Provide appropriate consultation and referral to Case Management or QUEST Integration program as appropriate.
Performs all other miscellaneous responsibilities and duties as assigned or directed.
Knowledge of the appropriate protocol to be followed for a given diagnosis and the normative values of medical tests and procedures.
Good communication skills both verbally and written.
Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, and Outlook.
Utilization Review Nurse (40 Hour) (Office/On-Site)
By State of Connecticut - Department of Mental Health & Addiction Services At , New Haven, 06519, Ct $76,565 - $103,779 a year
Interviews will be limited to candidates whose experience and training most closely meet the requirements of the position.
Experience with Medicare Part B billing requirements
MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE
MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE
Extensive pension plan and supplemental retirement offerings
Review the eligibility and documentation requirements for CT license by endorsement of an out-of-state license;
Utilization Review Nurse - Prn
By Johns Hopkins University At , Baltimore, 21218, Md $50 an hour

Requisition #: 625898 Location: Johns Hopkins Health Plans, Hanover, MD 21076 Category: Nursing Schedule: Day Shift Who you are: As an experienced Utilization Review RN with Managed ...

Utilization Management Nurse Jobs
By MFS Talent At Palo Alto, CA, United States
Maintain guidelines, federal and state regulations, payer requirements, and best practices related to utilization management.
Educate healthcare professionals and staff on utilization management principles, documentation requirements, and regulatory updates.
Case Management or Utilization Management certification or willingness to obtain within 2 years of hire.
Maintain accurate and thorough documentation of utilization management activities, including reviews, decisions, and interventions.
Identify opportunities for process improvement and participate in quality assurance activities related to utilization management.
Three (3) years of progressively responsible and directly related work experience, preferred.
Medical Review Nurse - Entry Level
By Qlarant At Dallas, TX, United States
Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
Experience in ICD-9 coding, CPT coding, and knowledge of Medicare and/or Medicaid regulations.
Current RN license. An LVN will not meet the contract's requirements.
Employment history that shows progressively responsible experience.
Strong Medicare and/or Medicaid knowledge.
Completes desk review or field audits to meet applicable contract requirements and to identify evidence of potential overpayment or fraud.

Are you looking for a challenging and rewarding career as a Utilization Review Nurse? Join our team and help us make a difference in the lives of our patients! We offer competitive salaries, excellent benefits, and a supportive team environment. Come join us and make a positive impact on the healthcare industry!

Overview:

Utilization Review Nurses are responsible for ensuring that healthcare services are provided in a cost-effective and efficient manner. They review patient records to determine the appropriateness of care and services, and to ensure that they are in compliance with the standards of care. Utilization Review Nurses also provide education and support to healthcare providers and patients on the utilization of healthcare services.

Detailed Job Description:

Utilization Review Nurses are responsible for reviewing patient records to ensure that healthcare services are provided in a cost-effective and efficient manner. They analyze patient records to determine the appropriateness of care and services, and to ensure that they are in compliance with the standards of care. Utilization Review Nurses also provide education and support to healthcare providers and patients on the utilization of healthcare services. They may also be responsible for developing utilization review plans, monitoring utilization trends, and providing recommendations for improvement.

What is Utilization Review Nurse Job Skills Required?

• Knowledge of healthcare regulations and standards of care
• Ability to analyze patient records
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Proficiency in computer applications
• Ability to work with a variety of healthcare providers

What is Utilization Review Nurse Job Qualifications?

• Bachelor’s degree in Nursing or related field
• Current Registered Nurse (RN) license
• Experience in utilization review or related field
• Knowledge of healthcare regulations and standards of care

What is Utilization Review Nurse Job Knowledge?

• Knowledge of healthcare regulations and standards of care
• Knowledge of medical terminology
• Knowledge of healthcare reimbursement systems
• Knowledge of healthcare quality improvement processes

What is Utilization Review Nurse Job Experience?

• Previous experience in utilization review or related field
• Previous experience in healthcare reimbursement
• Previous experience in healthcare quality improvement

What is Utilization Review Nurse Job Responsibilities?

• Review patient records to determine the appropriateness of care and services
• Monitor utilization trends and provide recommendations for improvement
• Develop utilization review plans
• Educate healthcare providers and patients on the utilization of healthcare services
• Ensure compliance with healthcare regulations and standards of care
• Maintain accurate and up-to-date records