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Utilization Review Nurse Selecthealth Jobs

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
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 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 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.
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
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.