Register
Recruit Create CV

Utilization Review Nurse – Care Management 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 - Health Care Professional - Lvn/Lpn/Physical Therapist
By EK Health Services Inc At , San Jose $30 - $31 an hour
Starts at $30-31+ per hour based on experience, education, and certifications.
Possess one of the following certifications: (RN, DC, PT, DPT, LVN, OT, LAc).
1 year of clinical experience
Knowledgeable with computer programs (MS Word, MS Excel, Email) and toggling between multiple screens.
Medical, Dental & Vision Insurance
Paid Time Off & Paid Holidays
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 Management Nurse - Pchp
By Parkland Health and Hospital System At , Dallas, 75201
Three years of experience in an acute clinical nursing or medical management setting.
Knowledge of utilization management and case management principles is preferred.
May have an equivalent combination of education and experience to substitute for the experience requirements.
Knowledge of NCQA, Federal and Texas Medicaid Utilization Management (UM) regulations.
Three years of managed care experience is preferred.
Provides appropriate consultation and referral to case management.
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.
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
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
Utilization Management Nurse Consultant
By CVS Health At , Arnold $28.25 - $60.50 an hour
2+ years of recent acute hospital clinical experience as an RN (recent defined as in the past 10 years).
Experience with all types of Microsoft Office including PowerPoint, Excel, and Word
Must have an active and unrestricted RN license
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 ...

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.
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.

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 Management Nurse, Consultant
By Blue Shield of California At , Rancho Cordova, 95670 $109,120 - $163,680 a year
Previous experience in utilization management preferred
Working knowledge of regulatory and accreditation standards preferred (URAC, NCQA, DMHC, Case Management Society of America CMSA)
Requires a bachelor's degree or equivalent experience
Requires at least 7 years of prior relevant experience
Strong computer skills related to Windows-based programs and applications
Strong clinical documentation skills, independent problem identification and resolution skills
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 Management Nurse Consultant
By CVS Health At , $28.25 - $60.50 an hour
This candidate will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Weekend/holiday coverage will occasionally be required
Communicates with providers and other parties to facilitate care/treatment
Utilization Management Nurse Consultant
By CVS Health At , Opelousas $28.25 - $60.50 an hour
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
Identifies members who may benefit from care management programs and facilitates referral
Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
3+ years of clinical practice experience in an inpatient setting required
2+ years of experience as a Registered Nurse
Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment