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Rn Utilization Review Full Time Rrmc Jobs

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/ Care Management – Full Time
By Montefiore Nyack Hospital At , Nyack From $110,000 a year

Description Comprehensively plans with the health care team to ensure patient needs are met and care delivery is coordinated across the continuum. Identifies and works to ...

Full Time, Hr Review Coordinator
By MEDICA101 LTD. At United States
Strong organizational and time management skills
2+ years of healthcare industry experience within a professional customer service or administrative type function
Knowledge of prior authorization or hospital admission processes preferred, however not required
Ability to manage multiple tasks and priorities
Analytical and critical thinking skills
Triage, research and enter acute inpatient hospital admissions
Full-Time: Rn Liaison Jobs
By Hospice Of Davidson County At Lexington, NC, United States

Position Description Nurse Liaison Primary Function : The Nurse Liaison is responsible for educating and promoting hospice services to the medical community, facilitating a smooth referral and ...

Rn - (Full-Time) Jobs
By Hudson Headwaters At Queensbury, NY, United States
Demonstrate proper medication and vaccine management processes.
Collaborate with staff and other departments in the development of strategies to continuously improve quality of care and the patient experience.
Demonstrate competence in clinical skill set.
Initiate patient and family education plan that meets the needs of the patient.
Provide guidance and mentor new and incumbent staff based on skill set.
Minimum of one-year Registered Nurse clinical experience preferred.
Rn - (Full-Time) Jobs
By Hudson Headwaters At Glens Falls, NY, United States
Demonstrate proper medication and vaccine management processes.
Collaborate with staff and other departments in the development of strategies to continuously improve quality of care and the patient experience.
Demonstrate competence in clinical skill set.
Initiate patient and family education plan that meets the needs of the patient.
Provide guidance and mentor new and incumbent staff based on skill set.
Minimum of one-year Registered Nurse clinical experience preferred.
Utilization Review Nurse Full Time – Care Management
By Montefiore Nyack Hospital At , Nyack, Ny

Description Comprehensively plans with the health care team to ensure patient needs are met and care delivery is coordinated across the continuum. Identifies and works to eliminate/minimize ...

Rn Utilization Review - Patient Access
By Penn State Health At , Enola, 17025, Pa
Communicates with the Medical Staff and Nursing Staff any utilization issues concerning patient care activities.
Presents Hospital Issued Notices of Non-coverage to patient/family and attending physician when patient's stay will no longer be covered by Medicare.
Acts as liaison between Hospital, physicians, patients and Medicare/Medicaid/Insurance review staff.
Performs preadmission and continued stay preauthorization for patients identified by Admissions as required this service.
Adheres to Federal and State rules as outlined.
Prepares monthly reports for review by the Medical Staff.
Utilization Review Rn - Providence Everett
By Providence Swedish At , Everett, 98201, Wa
Experience as an RN in an acute care setting within the last 5 years, OR recent Utilization Management experience.
Utilization review or case management experience.
Care Management, medical insurance or discharge planning experience.
Experience with InterQual or Milliman Criteria.
1 year - Experience with Neonatal Intensive Care (NICU) clientele.
Check out our benefits page for more information about our Benefits and Rewards.
Rn Utilization Review Prn
By Intermountain Healthcare At , Denver, Co $34.14 - $60.66 an hour
Minimum of three (3) years of case management experience
Collaborate with case managers, physicians, and payers related to status, coverage, benefits, and discharge planning as needed.
Work with multidisciplinary team to assess and improve denial management, documentation, and appeals process.
Understand CMS medical necessity requirements and the coordination of care required under Federal and State regulations.
Identify opportunities for physician education regarding length of stay, resource utilization and clinical documentation related to justification for hospital services.
At least five (5) years of nursing experience
Utilization Management Registered Nurse (Rn), Full Time, Days
By PIH HEALTH At , Downey, 90241, Ca $49.37 - $81.30 an hour
A minimum of 2 years of case management experience.
Excellent verbal and written communication skills
Self-motivated and results oriented. Must be able to demonstrate sound decision making, flexibility and prioritization skills with minimal supervision.
Basic computer skills: Word, Excel, PowerPoint, Outlook. Able to utilize multiple electronic systems.
A minimum of 2 years of bedside nursing experience in an acute care setting.
Certified Case Manager or Accredited Case Manager preferred
Rn Utilization Review Ii-Hybrid-Part-Time-Weekends And 1 Day Per Week
By Centra Health At ,

RN UTILIZATION REVIEW II-Hybrid-Part-Time-Weekends and 1 Day per Week

Be yourself. Be a partner with Centra.

Rn-Utilization Review Jobs
By Ascension At , Jacksonville, 32204, Fl 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.
Provide health care services regarding admissions, case management, discharge planning and utilization review.
Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
Licensure / Certification / Registration:
Schedule: Part-Time Saturday and Sunday 7:00am-7:00pm
Utilization Review Rn - Remote
By Guidehouse At District of Columbia, United States
Minimum of 3 years clinical experience. Minimum of 2 years Utilization Management experience.
The Remote Utilization Management Nurse
Supports the care management model as a working partner with providers, facilities, care managers, social workers, pharmacists, and other professional staff.
Able to adhere to communicated utilization management productivity metrics, including call volume and reviews.
Identify and refer complex risk members to care management.
Completes documentation in a timely, complete, and accurate manner in accordance with client benefits, guidelines, and regulatory requirements.
Utilization Management Case Manager Full Time
By UHS At Auburn Hills, MI, United States
Familiarity with managed health care process, medical terminology, experience in case management, discharge planning, and/or utilization review preferred.
UTILIZATION MANAGEMENT - CASE MANAGER -
Experience in settings that include inpatient or partial hospitalization preferred.
Challenging and rewarding work environment
Competitive Compensation & Generous Paid Time Off
Excellent Medical, Dental, Vision and Prescription Drug Plan
Rn - Full Time
By CenterWell Home Health At Las Vegas, NV, United States

DescriptionResponsibilitiesAs a Home Health Registered Nurse, you will:Provide admission, case management, and follow-up skilled nursing visits for home health patients.Administer on-going care and ...

Virtual Utilization Review Specialist - Weekend - Full Time
By Ensemble Health Partners At , Remote
Maintains clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilities (i.e., medical necessity criteria, MS-DRGs, POA).
Other Knowledge, Skills, and Abilities Required:
Communicates all medical necessity review outcomes to in-house care management staff and relevant parties as needed.
Demonstrates active collaboration with other members of the health care team to achieve the outcomes management goals including CMS indicators.
Documentation will reflect all work and communication related to the FCC, payor, physician, physician advisor and in-house care management.
Directs physician and patient communication regarding non-coverage of benefits.
Rn Utilization Review-Prn Jobs
By Johns Hopkins University At , Baltimore, 21218, Md

EDUCATION AND EXPERIENCE REQUIRED :

Rn Utilization Review Full Time Rrmc
By Riverside Regional Medical Center At , Newport News, 23601, Va
3-4 years Clinical nursing experience (Required)
As a Riverside Health System team member, our benefits have you covered:
Program Graduate, Professional Nursing (Required)
Registered Nurse (RN) - State Department of Health Professions (Required)
This position is located on site at Riverside Regional Medical Center in the Emergency Department working 12 hour shifts.
Vision and Dental plans (including orthodontic care)