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Registered Nurse Utilization Review Jobs in Fremont, Iowa

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.
Lvn - Utilization Review Nurse
By Intercare Holdings Insurance Services At , Remote $51,700 - $80,000 a year
Must have strong time management skills
Identify the need for medical case management and make recommendation for referral through supervisor
California Worker’s Compensation, Managed Care experience/Utilization Review experience desired
Will refer potential non-certification cases to peer clinical reviewers.
Will work closely with the client, claims handler, nurse case manager and supervisor, and take directions when needed.
Assist in the notification process for the non-certification issued by the physician reviewer
Clinical Care Reviewer, Utilization Management Review, Registered Nurse, Remote
By AmeriHealth Caritas At , Remote
Experience performing utilization management reviews (prior authorization and concurrent reviews) in a managed care organization.
3 or more years of experience in a related clinical setting as a Registered Nurse.
Strong written and verbal communication skills.
Associate’s Degree required; Bachelor’s Degree preferred.
Current unrestricted North Carolina or compact Registered Nurse license required.
Proficiency utilizing MS Office and electronic medical record and documentation programs.
Utilization Management Review Nurse (11:00A-7:30P Shift)
By DANE STREET LLC At , Remote
Utilization Management experience is strongly preferred.
Experience working in a remote environment is preferred.
Serves as an additional level of QA and clinical knowledge/review for cases with quality Issues.
Experience in a medical office or health care background.
Excellent written and verbal communication skills are required.
Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc. is a plus).
Utilization Review Nurse - Lvn/Lpn
By HealthComp At , Remote
1 year of recent experience in Utilization Review or Utilization Management at a health plan or other managed care organization preferred.
2-3 years clinical nursing experience required.
Authorized to work in the US
Utilization Review Coordinator Jobs
By HealthComp At , Remote $20 - $28 an hour
Perform clerical/administrative duties in the utilization and case management department.
Accurate data entry skills (40wpm)
Full offering of health and wellness benefits for you and your family
Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.
Strong written and verbal communication skills
Excellent interpersonal and communication skills
Utilization Review Nurse- Weekend 12Hr Shift
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
Experience with InterQual and/or MCG criteria
Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual or MCG criteria.
Participate in telephonic discussions with emergency department physicians relative to documentation and admission status.
Utilization Management Registered Nurse, Rn
By Humana At , Tampa, 33610, Fl
Previous experience in utilization management
Minimum 3 years medical surgery, heart, lung, critical care, skilled or rehabilitation nursing experience
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Previous Medicare/Medicaid Experience a plus
This is a remote position.
Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
Specialist , Utilization Review Jobs
By Oaklawn Hospital At , Marshall, Mi
Prepares any reports assigned or requested by the Manager of Case Management or his/her supervisor
Understands and communicates insurance information to team members, including benefits and levels of care
Conducts concurrent or extended stay reviews on appropriate day and/or specified time
Prepares and submits appeals to payors, effectively coordinating collection of all pertinent data to support the hospital and patient’s position
Maintains and updates reviews in the electronic medical record (EMR) and maintains other appropriate records as needed
Communicates pertinent payor issues to physician and other caregivers
Weekend Utilization Management Front End Review Registered Nurse
By Humana At , Tampa, 33610, Fl
Previous experience in Utilization Management
3 or more years experience preferably in an acute care- inpatient hospital setting.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Strong general computer skills in an autonomous work setting.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Utilize MCG criteria to perform acute concurrent front end reviews on Humana members to determine medical necessity.
Remote Registered Nurse - Medical Review Specialist
By Avosys Technology, Inc. At San Antonio, TX, United States
Years of experience in supporting, administering, managing content management platform such as Sharepoint
years of experience in supporting, administering, managing content management platform such as Sharepoint
Maximize family time with no weekend, Holiday, or on-call requirements
Take advantage of our competitive, comprehensive benefits package including medical, dental, vision, life, short-term disability, long-term disability & 401(k)
Ensure that all documentation includes a valid signature consistent with the signature requirements
Complete one-on-one provider education (i.e., webinar, conference call, etc.) within 30 days of sending out review results letter
Utilization Review Registered Nurse (Rn), Care Coordination, Full Time, Days
By MarinHealth Medical Center At , Greenbrae $66.03 - $99.04 an hour
Basic knowledge of government and private insurance benefits (e.g. Medi-Cal, Medicare, DRGs, and managed care), including reimbursement requirements is needed.
Experience in applying evidence based criteria related to utilization management.
Experience using case management software
National certification in Case Management preferred
Complies with all reporting requirements for mandated, risk management, and other medical/legal situations consistent with confidentiality policies and department standards.
Must be assertive and creative in problem solving, system planning and management.
Utilization Review Nurse-Weekends Jobs
By Sentara Healthcare At , Virginia Beach, 23462
Must possess 2-3 years of acute care clinical experience.
Previous Utilization Review experience a plus.
InterQual or Milliman experience preferred.
This position is Remote, Weekend Days.
Bachelor’s Degree in Nursing preferred
Basic Life Support (BLS) - Other/National
Utilization Review Nurse - Outpatient
By Johns Hopkins University At , Baltimore, 21218

Requisition #: 627353 Location: Johns Hopkins Health Plans, Hanover, MD 21076 Category: Nursing Schedule: Day Shift Who you are: As a Utilization Review Registered Nurse for Johns ...

Utilization Review Nurse Jobs
By Samaritan Health Services At , Corvallis $40.88 - $60.03 an hour
Acute care utilization review, discharge planning or case management experience preferred.
Utilization Review or Case Management Certification preferred.
Experience and/or training in insurance benefits or covered services including Medicare and Medicaid required.
Three (3) years RN experience required.
Experience and/or training in computer applications required. Typing speed of 35 wpm preferred.
Three (3) years hospital nursing experience preferred.
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 Nurse Jobs
By Mercy At , Springfield, 65804
Education: Graduate of an accredited school of nursing.
Experience: 2-3 years acute care hospital setting.
Tuition Reimbursement up to $2,000 for continuing education
Licensure: Current license in the state of residence and/or employment.
Health/Dental/Vision available after day one
Annual contribution of $100 per month to eligible co-workers enrolled in the Dependent Care FSA
Manager, Utilization Management, Registered Nurse, Rn
By Humana At ,
Minimum 1 year Utilization Management Experience
Intermediate to advanced computer skills and experience with Microsoft Suite, Word, Excel, Outlook.
Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
Manager will travel twice a year to South Florida to attend meetings (See Additional Information below)
Minimum 1 year experience with any of the following Team Leadership, Project Leadership, or Subject Matter Expert, SME
Minimum 1-year progressive clinical experience preferably in an acute care clinical setting
Utilization Review Nurse - Outpatient
By Johns Hopkins Health Plans At , Hanover
Excellent verbal/written communication skills to effectively interact and work collectively with enrollees, physicians, facility staff and management staff
Understanding of managed care delivery systems and utilization management
1+ years’ experience in Managed Care/Utilization Review is required
Knowledge and expertise in utilizing various criteria sets (i.e. InterQual)
3+ years’ experience as an acute care RN
This position is eligible for remote work.
Utilization Review Nurse Selecthealth
By Intermountain Healthcare At , Murray $38.83 - $57.46 an hour

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

Anticipated job posting close date:

Utilization Review Nurse Jobs
By MEDSTAR HEALTH At , Washington, 20010
Associate degree in Nursing with five years of bedside nursing experience can be used in lieu of the Bachelor's degree requirement.
Prior experience as a Case Manager required
Knowledge of reimbursement models (commercial, managed care, Medicare) is preferred.
Prior experience in a hospital or office type setting preferred
Prior utilization review experience preferred
Knowledge of MS Office Suite
Utilization Review Nurse (Lpn)
By 1199SEIU Benefit and Pension Funds At , New York
Process prospective, concurrent, retrospective Utilization Management (UM) medical requests and 1st level appeal, adhering to Fund’s established timeframes
Tro ubleshoot and interve ne with difficult vendors/providers and assist with urgent/expedited/complex cases that require management level problem solution.
Work closely with medical advisors and management team for escalated complex UM requests
Perform special projects and assignments as directed by management
Authorize vendor services based on skilled need and or medical necessity applying relevant
Working experience utilizing Milliman Care Guidelines
Registered Nurse-Coordinator-Utilization Management-Full Time-Days-Detroit
By Henry Ford Health At , Detroit, 48202
Previous utilization management or case management experience preferred.
Minimum 3-5 years of clinical experience and strong working knowledge of disease process, required.
Benefits: Full time benefit package
Knowledge of outside regulatory agencies that interface with the institution.
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,

Are you a Registered Nurse looking for a rewarding career in Utilization Review? Join our team and help us ensure that our patients receive the best care possible. We offer a competitive salary and benefits package, and the opportunity to make a real difference in the lives of our patients. Apply now and start making a difference today!

A Registered Nurse Utilization Review (RNUR) is responsible for reviewing and evaluating the medical necessity of patient care and services provided by healthcare providers. They are responsible for ensuring that the services provided are medically necessary and meet the standards of quality and cost-effectiveness.

What is Registered Nurse Utilization Review Job Skills Required?

• Knowledge of medical terminology and coding
• Knowledge of healthcare regulations and standards
• Ability to analyze and interpret medical records
• Ability to communicate effectively with healthcare providers
• Ability to work independently and as part of a team
• Knowledge of computer systems and software

What is Registered Nurse Utilization Review Job Qualifications?

• Bachelor’s degree in Nursing or related field
• Current Registered Nurse (RN) license
• Previous experience in utilization review or related field

What is Registered Nurse Utilization Review Job Knowledge?

• Knowledge of medical terminology and coding
• Knowledge of healthcare regulations and standards
• Knowledge of computer systems and software

What is Registered Nurse Utilization Review Job Experience?

• Previous experience in utilization review or related field

What is Registered Nurse Utilization Review Job Responsibilities?

• Review and evaluate medical necessity of patient care and services
• Ensure services provided meet standards of quality and cost-effectiveness
• Monitor utilization of services to ensure compliance with regulations
• Communicate with healthcare providers regarding utilization of services
• Prepare reports and documentation related to utilization review
• Maintain current knowledge of healthcare regulations and standards