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Utilization Review Rn Jobs in Fremont, Iowa

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.
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.
Clinical Care Reviewer Ii-Rn - Post Acute Care With Utilization Review Management
By CareSource At , Remote $58,000 - $92,800 a year
Medical management experience is preferred
Time management and prioritization skills
Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards
Identify and refer appropriate members for Care Management
Provide guidance to non-clinical medical management staff
Provide guidance to and assist with oversight of LPN and LISW medical management staff
Utilization Review Specialist Jobs
By Southwest Florida Home Care, Inc. At , Remote
Yes, Home Health Care Experience is required and OASIS certification is preferred. Additional+2 years experience is preferred
Do you need Home Health Care Experience?
Growing Florida Home Care Organization
Team and family focused organization
Florida Nursing License LPN or RN compact accepted
Ability to review high volume documents with accuracy and efficiency
Licensed Utilization Review I (Contract)
By Elevance Health At , Remote
Knowledge of the medical management process strongly preferred.
Applies clinical knowledge to work with facilities and providers for care coordination.
Educates the member about plan benefits and contracted physicians, facilities and healthcare providers.
Refers treatment plans/plan of care to peer clinical reviewers in accordance with established criteria/guidelines and does not issue medical necessity non-certifications.
Facilitates accreditation by knowing, understanding, and accurately applying accrediting and regulatory requirements and standards.
Develops relationships with physicians, healthcare service providers, and internal and external customers to help improve health outcomes for members.
Manager, Utilization Management Rn
By Devoted Health At , Remote $112,100 - $135,200 a year
A minimum of 5 years experience doing utilization management at a health plan
Support and coach members to improve management of their chronic condition, including medication adherence and compliance
A minimum of 5 years experience as a manager of >=10 direct reports
Apply knowledge to suggest safe exercise routines, dietary plans, meditation or stress reduction techniques
A deep caring to make a change in the health care experience: you love to serve and make a difference
A minimum of 5 years of RN experience
Virtual Utilization Review Specialist - Weekend - Full Time
By Ensemble Health Partners At , Remote
Maintains clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilities (i.e., medical necessity criteria, MS-DRGs, POA).
Other Knowledge, Skills, and Abilities Required:
Communicates all medical necessity review outcomes to in-house care management staff and relevant parties as needed.
Demonstrates active collaboration with other members of the health care team to achieve the outcomes management goals including CMS indicators.
Documentation will reflect all work and communication related to the FCC, payor, physician, physician advisor and in-house care management.
Directs physician and patient communication regarding non-coverage of benefits.
Utilization Review Nurse - Lvn/Lpn
By HealthComp At , Remote
1 year of recent experience in Utilization Review or Utilization Management at a health plan or other managed care organization preferred.
2-3 years clinical nursing experience required.
Authorized to work in the US
Utilization Review Coordinator Jobs
By HealthComp At , Remote $20 - $28 an hour
Perform clerical/administrative duties in the utilization and case management department.
Accurate data entry skills (40wpm)
Full offering of health and wellness benefits for you and your family
Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.
Strong written and verbal communication skills
Excellent interpersonal and communication skills
Utilization Review Nurse- Weekend 12Hr Shift
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
Experience with InterQual and/or MCG criteria
Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual or MCG criteria.
Participate in telephonic discussions with emergency department physicians relative to documentation and admission status.
Utilization Review Coordinator (Rn), Behavioral Health-Per Diem
By Coast Plaza Hospital At , Norwalk, 90650, Ca
Possesses skill set to provide clerical support to the Case Management Department.
Excellent time management skills with a proven ability to meet deadlines.
Demonstrates knowledge and skill set to process BHU Medical TARS
Regularly attends required in-services and continuously takes an active interest in furthering one's knowledge.
Has the willingness and ability to perform all other duties and responsibilities as assigned
Five years + experience in acute care hospital Utilization Review and RN Required
Director Of Admission & Utilization Review
By Recovery Centers of America At , Greenville, 29615, Sc
Knowledge of pre-assessment and pre-certification reviews and able to perform appeal reviews.
Ability to work as a member of a management team.
Knowledge and experience of all continuums of care, including admission assessment and continued stay criteria
Ensures compliance with accreditation agency requirements.
Ensures compliance with the state requirements/guidelines.
Knowledge of discharge planning resources.
Specialist , Utilization Review Jobs
By Oaklawn Hospital At , Marshall, Mi
Prepares any reports assigned or requested by the Manager of Case Management or his/her supervisor
Understands and communicates insurance information to team members, including benefits and levels of care
Conducts concurrent or extended stay reviews on appropriate day and/or specified time
Prepares and submits appeals to payors, effectively coordinating collection of all pertinent data to support the hospital and patient’s position
Maintains and updates reviews in the electronic medical record (EMR) and maintains other appropriate records as needed
Communicates pertinent payor issues to physician and other caregivers
Utilization Management Rn Jobs
By AdventHealth Tampa At , Tampa, 33613, Fl
Minimum two year Utilization Management experience, or equivalent professional experience.
Strong analytical, data management, and computer skills
Minimum three years acute care clinical nursing experience required.
Excellent interpersonal communication and negotiation skill.
Mental Health Resources and Support
AdventHealth Pepin Heart Institute, known across the country for its advances in cardiovascular disease prevention, diagnosis, treatment and research.
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.
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.