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Utilization Review Rn Jobs in Ashland, Ohio

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
Prn-Ur Clinical Review Rn - Support Center (Remote)
By Children's Healthcare of Atlanta At , Brookhaven, 30329

Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Day ...

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
(F/T) - Utilization Review (Non-Rn) Case Manager - Umhc/Sccc - Miami
By University of Miami At , Miami, Fl
Accurate review of coverage benefits and limitations to determine continued appropriateness of services requested
Maintains knowledge regarding payer reimbursement policies and clinical guidelines.
Minimum of 2 years of relevant experience
Adhere and perform timely reviews for services requiring an authorization for continuation of care
Follows the authorization process using established criteria as set forth by the payer or clinical guidelines
Facilitates interdepartmental communication regarding status of continued authorization in advance of patient’s appointment.
Utilization Review Specialist(Ft)
By Cornerstone of Recovery At , Louisville, 37777, Tn
Notify supervisor when pre-certification is denied.
Develop collaborate relationships with third party payers and managed care companies
Continue education with new information regarding criteria for various insurance companies.
Track how particular Managed Care Companies approve residential days in keeping with progress notes under our ASAM criteria.
Average to above average computer skills.
Above average verbal and writing skills.
Rn Utilization Review/Case Management - Behavioral Health
By PeaceHealth At , Springfield, 97477, Or
Maintains issue tracker related to third party denials and interfaces with management as needed to initiate investigation of denials.
Oversees and supports staff with wound care and patient education.
Attends unit leadership meetings. Collaborates regarding unit issues and quality assurance. Provides staff education as appropriate.
Working knowledge of psychiatric diagnostics required
Third party reimbursement knowledge desirable
Willingness to work toward CPUR certification preferred
Rn Utilization Management - Onsite In Miami- Dade County - Travel Required
By Humana At , Miami, 33183, Fl
Previous experience in discharge planning, utilization management or case management a plus
2 or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Strong Written and verbal communication skills
Previous Medicare Experience a plus
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Utilization Management Rn Jobs
By UCHealth At , Aurora, 80045, Co $36.47 - $56.52 an hour
Tuition and continuing education reimbursement
Full suite of voluntary benefits such as identity theft protection and pet insurance
Full medical, dental and vision coverage
Retirement plans to include pension plan and 403(b) matching
Paid time off. Start your employment at UCHealth with PTO in your bank
Employer-paid life and disability insurance with additional buy-up coverage options
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.
Rn Utilization Management Reviewer
By Commonwealth Care Alliance At , Springfield, 01107, Ma
3+ years combined clinical and utilization management experience
Experience with utilization management platform preferred
Knowledge, Skills & Abilities Required:
Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy
3+ years' experience working in a health plan preferred
Strong collaboration and negotiation skills
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 ...

Continuing Care Utilization Review Coordinator Rn
By Kaiser Permanente At , Walnut Creek, 94598, Ca $71.25 - $92.17 an hour
Must be able to work in a Labor/Management Partnership environment.
Minimum one (1) year of utilization experience required.
Bachelors degree in nursing or health related field required, OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
Demonstrated knowledge of diagnostic codes.
Conducts utilization review for in-house patients and/or members who have been admitted to contracted facilities. Interviews patients/caregivers regarding care after hospitalization.
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.
Utilization Review Coordinator: Rn Or Msw
By The Carolina Center for Behavioral Health At , Greer, 29650
Maintain appropriate records of the Utilization Review Department.
Conducts admission reviews and pre-certs.
Conducts concurrent and extended stay reviews.
Prepares and submits appeals to third party payors.
Participates in activities which enhance professional growth and development.
Demonstrates conduct in keeping with CCBH’s ethical standards.
Utilization Review Rn Jobs
By TidalHealth At Salisbury, MD, United States
Strong analytical, data management and PC skills
Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement
3 or more years of strong clinical experience
Excellent interpersonal communication and negotiation skills
Utilization Review RN Position Requirements
Current and valid license to practice as a RN
Utilization Review Jobs
By CodeMax Medical Billing At Los Angeles, CA, United States

The Utilization Review Specialist will perform utilization review of pre-certification and concurrent clinical utilization reviews with insurance companies in accordance with certification ...

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.
Medicaid Utilization Review Analyst
By State of Idaho At , Coeur D'alene $26 an hour
(PERSI) that offers a lifetime benefit.
Excellent medical, dental and vision insurance- (full-time) employee only coverage for PPO $65/month for medical and vision & $11.00/month for dental
Generous vacation and sick leave accrual beginning as soon as you start
11 paid holidays a year
Multiple savings plans, optional 401K, and optional 457
An opportunity for student loan forgiveness
Behavioral Health, Utilization Management Review, Lcmhc/Lcsw/ Rn
By AmeriHealth Caritas At , Greensboro
Two or more years of behavioral health experience.
Strong problem solving skills and decision making skills.
This position requires residency in the state of North Carolina.
Current active professional licensure required in North Carolina: LCMHC, LCSW, RN
Proficiency in Microsoft Office, including Word, Excel and Outlook is required.
Ability to communicate in a positive/professional manner both orally and written.
Utilization Review Representative Jobs
By Ethos At Dallas, TX, United States
Receives, screens and manages mail, faxes and calls.
Collection and data entry of structured clinical data (including diagnosis, diagnosis codes, procedures, procedure codes).
Reviews service request for completeness of information.
Assigns reviews to Utilization Review Nurse
Assists with written determination letter communications via fax, e-mail or written mail under.
Maintains confidentiality and security in all aspects of performance.
Utilization Review Rn (Austin, Texas)
By Ascension At , Remote 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.
Schedule: Full-Time, 8-hour day shift, Monday - Friday, Fully Remote
Facility: Automated Benefit Services (ABS)
Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
Knowledge of Government Insurance Prgram plans.
Social Worker Msw - Utilization Review
By Providence At , Napa, 94581
1 year experience as a Social Worker or Counselor.
Check out our benefits page for more information about our Benefits and Rewards.
Master's Degree in Social Work or Counseling Psychology.
Concurrent Review Nurse, Rn - 23-246
By Hill Physicians Medical Group At , Sacramento

We’re delighted you’re considering joining us!

Rn Specialist Utilization Review
By HonorHealth At , Scottsdale, 85258
Determines qualifications for hospital level of care based on set criteria.
Initiates chart reviews, conducts follow-up reviews, and escalates secondary reviews to Physician Advisor as necessary.
Performs other duties as assigned.
Rn Utilization Management Jobs
By Carewise Health, Inc At , Remote
A minimum of three years utilization management experience working with individuals with complex care needs experience preferred.
Organization and time management skills are essential.
Utilizes nursing experience and judgment in addition to the client specific guidelines when determining medical necessity and quality check dates.
A minimum of three years clinical nursing experience preferred.
Intermediate level skills in Microsoft applications (Excel, Word, Outlook, and Windows environment).
Excellent verbal and written communication skills.
Case Manager Utilization Rn
By Kaiser Permanente At , Baldwin Park $58.43 - $71.51 an hour
Two (2) years combined RN experience in an acute care setting or case management required.
Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.
Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review/management, discharge planning or case management.
Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
Recommends alternative levels of care and ensures compliance with federal, state and local requirements.
Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
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.
Rn Utilization Review Jobs
By Edward-Elmhurst Health At , Naperville, 60540
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
Minimum of two years of utilization review and/or clinical experience
Minimum of two years of utilization review experience
Associate’s Degree or higher in Nursing
Current State of Illinois Registered Nurse licensure
Bachelor’s Degree in Nursing or health care related field
Benefit Review Rn - Remote | Wfh
By Get It Recruit - Healthcare At Philadelphia, PA, United States

Join our dynamic team and embark on an exciting journey in the world of healthcare management! We are seeking a passionate and dedicated individual to fill the role of Clinical Benefit Review ...

Supervisor Long Term Services & Support Utilization Management Review, Rn - Remote
By AmeriHealth Caritas At , Philadelphia, 19103
Monitors staff work assignments and makes appropriate adjustments based on staffing levels, staff experience, and number/request types of authorizations/appeals received.
Assesses candidates and ensures that optimal qualifications are met as a member of the department’s interview team.
Reviews quality audits and shares audit results in a timely manner with associates, providing necessary education and counseling to improve performance.
Responsible for writing and finalizing annual reviews for direct reports with Manager input.
Accurately answers questions regarding CHC benefits for members and providers.
Maintains awareness and complies with Plan CHC authorization timeliness standards based on DHS/NCQA requirements.
Senior Therapist - Youth Clinical Utilization Review
By City of Alexandria, VA At , Alexandria $66,460 - $89,027 a year
Implement Independent Assessment Certification & Coordination Team (IACCT) recommendations including locating residential treatment placements and intensive community based services;
Act as Family Assessment and Planning Team (FAPT) Case Manager for high needs youth and their families;
Engage families seeking residential services for their children in the Children’s Services Act (CSA) Parental Agreement process;
Provide consultation, coordination and monitoring when out-of-home behavioral health services are considered, including Parental Agreements;
Participate in multi-disciplinary planning meetings, court hearings, and relevant training, conferences and workshops;
Develop and monitor treatment plans with youth and their families based on their strengths, needs, preferences, and goals;
Utilization Review Specialist Jobs
By Department of Behavioral Healt At , Washington, Dc $87,339 - $111,749 a year
Traffic record check (as applicable);
Consumer credit check (as applicable);
Reasonable suspicion drug and alcohol test; and
Post-accident or incident drug and alcohol test.
RESIDENCY PREFERENCE AMENDMENT ACT OF 1988
Bachelor’s Degree in Nursing preferred.