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Utilization Review Nurse Jobs in Clark, Ohio

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 Management Nurse (Central Region)
By Humana At , Springfield, 65807, Mo
Utilization Management experience highly preferred
Prior clinical experience preferably in an acute care, hospital, skilled or rehabilitation clinical setting
Understands resources and role responsibilities as well as reporting structure
Follows established guidelines/procedures to ensure all work is compliant with CMS and NCQA requirements
2-5 years of acute care nursing experience
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Utilization Review Director Jobs
By Coastal Behavioral Health At , Savannah, 31406
Challenging and rewarding work environment
Excellent Medical, Dental, Vision and Prescription Drug Plan
401(K) with company match and discounted stock plan
Career development opportunities within UHS and its 300+ Subsidiaries
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
Utilization Review Nurse (40 Hour) (Office/On-Site)
By State of Connecticut - Department of Mental Health & Addiction Services At , New Haven, 06519, Ct $76,565 - $103,779 a year
Interviews will be limited to candidates whose experience and training most closely meet the requirements of the position.
Experience with Medicare Part B billing requirements
MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE
MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE
Extensive pension plan and supplemental retirement offerings
Review the eligibility and documentation requirements for CT license by endorsement of an out-of-state license;
Registered Nurse Coordinator - Utilization Review Clinical Care Management
By St. Joseph's Health At , Syracuse, 13203, Ny
Maintain the prescribed workload including work queue management, process oversight and committee responsibilities.
Education, Training, Experience, Certification and Licensure:
Participating in Revenue Cycle functions including work queue and account management, monitoring metrics, and attendance at meetings.
Participate in interdisciplinary meetings regarding UR and denials management, including retroactive chart reviews, data collection, and process development.
Maintain BLS/CPR certification. Maintain other certifications appropriate to field.
Career advancement to senior leadership roles such as Manager, Director or Administrative roles.
Utilization Mangement Nurse Consultant
By CVS Health At , , Mo $28.25 - $60.50 an hour

3+ years of experience as a Registered Nurse

Must have active current and unrestricted licensure in state of residence

Utilization Review Nurse Jobs
By Nascentia Health At , Syracuse, 13204, Ny
Three or more years of utilization management or quality improvement experience preferred.
Professional competencies, skills and abilities:
Creates and facilitates educational programs.
Identifies and collaborates with UR Manager on individual cases
Identifies and collaborates with UR Manager on trends in usage patterns.
Five or more years of home health care or long term care experience strongly preferred.
Registered Nurse (Rn), Utilization Review, Days, Remote
By UC Health At , Cincinnati, 45229, Oh
1 year of Utilization Review experience, minimum required
Gives clear instructions to patients/family regarding treatment, and involves family/guardian in the assessment, initial treatment, and continuing care of the patient.
Demonstrates critical thinking, accountability, flexibility, and a cooperative attitude in meeting the needs of the unit.
Nursing process is accurately and concisely documented, including evaluation of treatment and in accordance to hospital policy and procedure.
Acts as a resource person and mentor for new personnel, floater, and/or supplemental staff working on the unit.
Assumes responsibility for personal professional development and contributes to the professional development of peers, colleagues, and others.
Utilization Management Nurse – Mid-West Region
By Humana At , Cincinnati, 45202, Oh
Utilization Management experience highly preferred
Understands resources and role responsibilities as well as reporting structure
Follows established guidelines/procedures to ensure all work is compliant with CMS and NCQA requirements
2 or more years of acute care nursing experience
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Nurse Auditor Review 2 - Remote, Nationwide
By Humana At , Troy, 48083, Mi
This role will be performed 100% remotely/work at home.
CPT coding experience or certification
18 months of medical record or coding auditing experience
Ability to work independently and manage work load
Excellent writing, editing, interpersonal, planning, teamwork, and communications skills
Experience applying CMS manual, NCCI edits, LCD / NCD documentation to audits
Utilization Management Nurse Consultant
By CVS Health At , , Oh $28.25 - $60.50 an hour
3+ years of experience as a Registered Nurse
3+ years of clinical experience
Must have active current unrestricted RN licensure in state of residence
Must be available to work M-F 8am-5pm
Utilization Management Nurse Consultant
By CVS Health At , Jacksonville, Al $28.25 - $60.50 an hour

3+ years of clinical experience

Must have active current and unrestricted Registered Nurse licensure in state of residence

Utilization Management Nurse - Weekends (Mid-West Region)
By Humana At , Troy, 48083, Mi
Utilization Management experience highly preferred
Prior clinical experience preferably in an acute care, hospital, skilled or rehabilitation clinical setting
Understands resources and role responsibilities as well as reporting structure
Follows established guidelines/procedures to ensure all work is compliant with CMS and NCQA requirements
3-5 years of acute care nursing experience
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Utilization Management Nurse - Weekends (Mid-West Region)
By Humana At , Louisville, 40202, Ky
Utilization Management experience highly preferred
Prior clinical experience preferably in an acute care, hospital, skilled or rehabilitation clinical setting
Understands resources and role responsibilities as well as reporting structure
Follows established guidelines/procedures to ensure all work is compliant with CMS and NCQA requirements
3-5 years of acute care nursing experience
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Utilization Review Assistant - Remote Opportunity
By Martin's Point Health Care At , Portland, Me
Basic knowledge of medical terminology, current healthcare benefits and managed care insurance plans
Participates in and contributes to Health Management Department meetings and process improvement initiatives.
Associates Degree or equivalent combination of education and experience
2 years of managed care experience including experience in a call center
Manages the authorization review queues including monitoring for timeliness of responses.
Manages fax queues including uploading faxes to the UM authorization system.
Rn, Utilization Review Jobs
By Cincinnati Children's Hospital At , Cincinnati, 45219, Oh $30.91 - $38.92 an hour
Case Management Certification through CCM or ACMA
3 or more years of inpatient RN experience
BSN from ACEN, CCNE or NLN CNEA accredited institution or MSN
Active Ohio RN License. May be required to obtain other state licensure.
Rn, Utilization Review - Remote | Wfh
By Get It Recruit - Healthcare At Cincinnati, OH, United States

We're looking for a talented Utilization Review Nurse to join our team! As a Utilization Review Nurse, you'll use your skills and expertise to help us manage the cost of health care benefits and ...

Utilization Management Nurse Jobs
By Humana At , Cincinnati, 45202, Oh
Previous experience in utilization management, discharge planning and/or home health or rehab
Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
The Utilization Management Nurse 1:
Experience with Preadmission Screening and Resident Review (PASRR)
Experience with Minimum Data Set (MDS)
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Rn - Case Manager I - Utilization Review
By The University of Mississippi Medical Center At , Jackson, 39216, Ms
Please complete this application in entirety by providing all of your work experience, education and certifications/
Drives appropriate policy/practice change through research, knowledge, and skills.
Management retains the right to add or change duties at any time.
You must meet all of the job requirements at the time of submitting the application.
Works to manage patient flow and safety to assure appropriate throughput, contributing to organizational financial wellbeing.
You can only apply one time to a job requisition.

Are you looking for a challenging and rewarding career as a Utilization Review Nurse? Join our team and help us make a difference in the lives of our patients! We offer competitive salaries, excellent benefits, and a supportive team environment. Come join us and make a positive impact on the healthcare industry!

Overview:

Utilization Review Nurses are responsible for ensuring that healthcare services are provided in a cost-effective and efficient manner. They review patient records to determine the appropriateness of care and services, and to ensure that they are in compliance with the standards of care. Utilization Review Nurses also provide education and support to healthcare providers and patients on the utilization of healthcare services.

Detailed Job Description:

Utilization Review Nurses are responsible for reviewing patient records to ensure that healthcare services are provided in a cost-effective and efficient manner. They analyze patient records to determine the appropriateness of care and services, and to ensure that they are in compliance with the standards of care. Utilization Review Nurses also provide education and support to healthcare providers and patients on the utilization of healthcare services. They may also be responsible for developing utilization review plans, monitoring utilization trends, and providing recommendations for improvement.

What is Utilization Review Nurse Job Skills Required?

• Knowledge of healthcare regulations and standards of care
• Ability to analyze patient records
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Proficiency in computer applications
• Ability to work with a variety of healthcare providers

What is Utilization Review Nurse Job Qualifications?

• Bachelor’s degree in Nursing or related field
• Current Registered Nurse (RN) license
• Experience in utilization review or related field
• Knowledge of healthcare regulations and standards of care

What is Utilization Review Nurse Job Knowledge?

• Knowledge of healthcare regulations and standards of care
• Knowledge of medical terminology
• Knowledge of healthcare reimbursement systems
• Knowledge of healthcare quality improvement processes

What is Utilization Review Nurse Job Experience?

• Previous experience in utilization review or related field
• Previous experience in healthcare reimbursement
• Previous experience in healthcare quality improvement

What is Utilization Review Nurse Job Responsibilities?

• Review patient records to determine the appropriateness of care and services
• Monitor utilization trends and provide recommendations for improvement
• Develop utilization review plans
• Educate healthcare providers and patients on the utilization of healthcare services
• Ensure compliance with healthcare regulations and standards of care
• Maintain accurate and up-to-date records