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Case Management Utilization Review Rn Jobs

Travel Rn - Case Management
By Host Healthcare, Inc. At Lakewood, CO, United States
We offer the best pay for our travelers
Day one medical, dental, and vision insurance
License, travel, tuition, and scrub reimbursement
Deluxe private housing or generous housing stipend
Discounts to your favorite activities, restaurants, health & beauty brands, shopping and hotels
Travel Happy With Host Healthcare
Travel Rn - Case Management
By TactStaff At Falls Church, VA, United States

Tact Staff is seeking a travel nurse RN Case Management for a travel nursing job in Falls Church, Virginia. Job Description & Requirements Specialty: Case Management Discipline: RN Start ...

Rn Care Manager- Utilization Management
By The CGC Group At New York, NY, United States
Managed care experience or Case Management experience.
Provide utilization management as needed to ensure coordination of health care delivery.
Identify members at risk and refers for Care management and/or disease management as needed.
RN with an active, unrestricted nursing license (Concurrent Review, Medical Management, etc.)
Effectively able to screen and stratify members who are appropriate for care management services.
Ability to create and execute care management care plans and document per EH’s policies and procedures.
Utilization Review Coordinator: Rn Or Msw
By The Carolina Center for Behavioral Health At , Greer, 29650
Maintain appropriate records of the Utilization Review Department.
Conducts admission reviews and pre-certs.
Conducts concurrent and extended stay reviews.
Prepares and submits appeals to third party payors.
Participates in activities which enhance professional growth and development.
Demonstrates conduct in keeping with CCBH’s ethical standards.
Utilization Review Rn Jobs
By TidalHealth At Salisbury, MD, United States
Strong analytical, data management and PC skills
Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement
3 or more years of strong clinical experience
Excellent interpersonal communication and negotiation skills
Utilization Review RN Position Requirements
Current and valid license to practice as a RN
Behavioral Health, Utilization Management Review, Lcmhc/Lcsw/ Rn
By AmeriHealth Caritas At , Greensboro
Two or more years of behavioral health experience.
Strong problem solving skills and decision making skills.
This position requires residency in the state of North Carolina.
Current active professional licensure required in North Carolina: LCMHC, LCSW, RN
Proficiency in Microsoft Office, including Word, Excel and Outlook is required.
Ability to communicate in a positive/professional manner both orally and written.
Registered Nurse - Utilization Review Case Manage - Peds/Adults - 8 Hour Days
By CEDARS-SINAI At , Los Angeles $52.47 - $83.95 an hour

lifting, standing, walking, sitting, typing, reaching, repetitive motions

Utilization Review Rn (Austin, Texas)
By Ascension At , Remote From $69,555 a year
Provide case management and/or consultation for complex cases.
Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
Schedule: Full-Time, 8-hour day shift, Monday - Friday, Fully Remote
Facility: Automated Benefit Services (ABS)
Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
Knowledge of Government Insurance Prgram plans.
Rn - Case Management
By Lead Health At Torrance, CA, United States

Travel, Licensure, and Certification Reimbursements

Rn Utilization Management Reviewer
By Commonwealth Care Alliance At , Boston, 02108
3+ years combined clinical and utilization management experience
Experience with utilization management platform preferred
Knowledge, Skills & Abilities Required:
Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy
3+ years' experience working in a health plan preferred
Strong collaboration and negotiation skills
Rn Specialist Utilization Review
By HonorHealth At , Scottsdale, 85258
Determines qualifications for hospital level of care based on set criteria.
Initiates chart reviews, conducts follow-up reviews, and escalates secondary reviews to Physician Advisor as necessary.
Performs other duties as assigned.
Travel Rn - Case Management
By KPG Healthcare At Pittsfield, MA, United States
What KPG Healthcare can offer you:
8, 13, 26 week assignment
Housing or Housing stipend provided
Weekly Pay with direct deposit
Rn Utilization Management Jobs
By Carewise Health, Inc At , Remote
A minimum of three years utilization management experience working with individuals with complex care needs experience preferred.
Organization and time management skills are essential.
Utilizes nursing experience and judgment in addition to the client specific guidelines when determining medical necessity and quality check dates.
A minimum of three years clinical nursing experience preferred.
Intermediate level skills in Microsoft applications (Excel, Word, Outlook, and Windows environment).
Excellent verbal and written communication skills.
Rn Coordinator Utilization Management (1.0 Fte)
By Network Health At , Menasha, 54952
Provides education regarding utilization management activities and processes to members, caregivers, providers, and their administrative staff.
Experience in insurance, managed care and utilization management preferred.
Participates in Utilization Management auditing (i.e. Utilization Management Inter-reviewer reliability and denial files).
Supports Utilization Management department programs and goals through active participation.
Identifies and screens candidates for Case Management intervention and determines appropriate level of care from Utilization Management criteria.
Performs other duties and responsibilities as assigned.
Case Manager Utilization Rn
By Kaiser Permanente At , Baldwin Park $58.43 - $71.51 an hour
Two (2) years combined RN experience in an acute care setting or case management required.
Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.
Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review/management, discharge planning or case management.
Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
Recommends alternative levels of care and ensures compliance with federal, state and local requirements.
Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
Registered Nurse, Utilization Review, Rn
By BJC HealthCare At , St. Louis, 63144 $68,224 - $104,811 a year
Must have at least one year of Utilization Review experience to be considered!
100% Remote position; however, must live in the St. Louis metro area!
Ideal candidate will have the following experience:
Experience managing an assignment of labor/delivery and mom/baby admissions to obtain authorizations
Knowledge and use of the CMS 2 Midnight process
Uses clinical and analytical skills to review and interpret diagnostic test results to determine appropriateness of patient's level of care.
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 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
Supervisor Long Term Services & Support Utilization Management Review, Rn - Remote
By AmeriHealth Caritas At , Philadelphia, 19103
Monitors staff work assignments and makes appropriate adjustments based on staffing levels, staff experience, and number/request types of authorizations/appeals received.
Assesses candidates and ensures that optimal qualifications are met as a member of the department’s interview team.
Reviews quality audits and shares audit results in a timely manner with associates, providing necessary education and counseling to improve performance.
Responsible for writing and finalizing annual reviews for direct reports with Manager input.
Accurately answers questions regarding CHC benefits for members and providers.
Maintains awareness and complies with Plan CHC authorization timeliness standards based on DHS/NCQA requirements.
(F/T) - Utilization Review (Non-Rn) Case Manager - Umhc/Sccc - Miami
By University of Miami At , Miami, Fl
Accurate review of coverage benefits and limitations to determine continued appropriateness of services requested
Maintains knowledge regarding payer reimbursement policies and clinical guidelines.
Minimum of 2 years of relevant experience
Adhere and perform timely reviews for services requiring an authorization for continuation of care
Follows the authorization process using established criteria as set forth by the payer or clinical guidelines
Facilitates interdepartmental communication regarding status of continued authorization in advance of patient’s appointment.