Register
Recruit Create CV

Utilization Review Nurse Jobs in Virginia

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 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 Pchp-(Ft/Days)
By Centra Health At , , Va

Be yourself. Be a partner with Centra.

Utilization Review Nurse - Inpatient
By Johns Hopkins HealthCare At , Hanover, 21076, Md
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
3+ years’ experience in Managed Care/Utilization Review in MCO is required
We’d like you to have the following education/experience:
Knowledge and expertise in utilizing various criteria sets (i.e. InterQual)
3+ years’ experience as an acute care RN
Utilization Managment Nurse Consultant
By CVS Health At , Chantilly, Va $28.25 - $60.50 an hour
3+ years of experience as a Registered Nurse
Must have active current and unrestricted RN licensure in state of residence
Must be available to work M-F 8am-5pm EST and willing to work 1 major and 1 minor holiday annually
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)
Utilization Nurse Jobs
By US Veterans Health Administration At , Bedford, 01730, Ma $82,321 - $162,414 a year
If you are relying on your education to meet qualification requirements:
Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required.
You will be evaluated for this job based on how well you meet the qualifications above.
IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE MAY NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE.
U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
Utilization Review Nurse Jobs
By Sentara Healthcare At , Norfolk, 23502, Va
Accreditation and Regulatory Previous Experience
Registered Nurse License (RN) - Virginia
Registered Nurse License (RN) - Compact/Multi-State License
Registered Nurse License (RN) - North Carolina
Utilization Review Nurse Jobs
By Sentara Healthcare At , Newport News, 23601, Va
Must possess 2-3 years of acute care clinical experience.
Previous Utilization Review experience a plus.
InterQual or Milliman experience preferred.
Accreditation and Regulatory Previous Experience
Bachelor’s Degree in Nursing preferred
Registered Nurse License (RN) - Virginia

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