Register
Recruit Create CV

Utilization Review Rn Jobs in Zapata, Texas

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.
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.
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.
Medical Review Rn -Experienced - Home Or Office Based
By Qlarant At Dallas, TX, United States
Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
ICD-9 coding, CPT coding, and knowledge of Medicare and/or Medicaid regulations preferred. CPC or similar certification preferred.
Completes desk review or field audits to meet applicable contract requirements and to identify evidence of potential overpayment or fraud.
Consults with Benefit Integrity investigation experts and pharmacists for advice and clarification.
Responsible for case specific or plan specific data entry and reporting.
Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data.
Utilization Review Specialist Jobs
By Within Health At Houston, TX, United States
MUST HAVE EXPERIENCE WITH EATING DISORDER CLIENTS*
Complete precertification process and associated documentation.
Manages time effectively, setting priorities, and consistently meeting deadlines.
Excellent verbal and written communication skills.
Maintain efficient methods for ensuring the medical necessity and appropriateness of prescribed level of care.
Oversee the entire UR process for client journey from admission to discharge.
Utilization Management Rn Jobs
By Children's Health At , Dallas, 75390, Tx
Accountable for current knowledge of utilization management responsibilities, including: payer information; business rules; regulatory guidelines; and policies and procedures.
At least 1 year Utilization Review or Case Management experience Preferred
Escalate payer problems to UM RN II or Denials Management Specialist
Identifies issues and strategies to modify and/or enhance the utilization management program.
Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification Preferred
Maintains productivity and optimum case load, delegating appropriately to maximize skills set, productivity and effectiveness.
Rn Utilization Review - Patient Access
By Penn State Health At , Enola, 17025, Pa
Communicates with the Medical Staff and Nursing Staff any utilization issues concerning patient care activities.
Presents Hospital Issued Notices of Non-coverage to patient/family and attending physician when patient's stay will no longer be covered by Medicare.
Acts as liaison between Hospital, physicians, patients and Medicare/Medicaid/Insurance review staff.
Performs preadmission and continued stay preauthorization for patients identified by Admissions as required this service.
Adheres to Federal and State rules as outlined.
Prepares monthly reports for review by the Medical Staff.
Utilization Review Specialist - Casual
By Nebraska Methodist Health System At , Omaha, 68118, Ne
Maintains knowledge of Payer requirements for peer to peer process, Skilled nursing facility authorization, & LTAC reviews.
Provides provider and care team ongoing education regarding utilization review/management.
Verifies authorization of services and communicates information to case management/nursing team.
Makes decisions based on evidence based practice, research, and UR nurse higher order critical thinking skills and experience.
Maintains knowledge of Payer requirements regarding length of stay for observation and transition to Inpatient
Documents actions taken and outcome(s) in Cerner Case Management tool, payer information.
Rn Utilization Management Jobs
By Ascension At , Bulverde, 78163, Tx From $69,555 a year
Department: Ascension Care Management Insurance
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.
Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
BSN with at least 3 years of nursing experience
Health plan or inpatient utilization experience
Utilization Review Case Mgr-Cmc-Baybrook
By UTMB Health At , Galveston, 77555, Tx
Collaborates with care managers, providers, nursing and pharmacy to facilitate identified discharge needs and ensure services provided at destination infirmary.
Salary is commensurate with years of relevant work experience.
Monitors and facilitates appropriate utilization of resources and provides alternative options to hospital care (i.e., infirmary placement, urgent clinic).
Functions as a resource to physicians and nursing staff regarding approved criteria, specialty practice guidelines, and alternative treatment options.
Provides 24/7 access to care and care coordination through the telephone call center.
Adheres to internal controls established for department.
Utilization Review Specialist Jobs
By St. Charles Health System At , Bend, 97701, Or $24.32 - $33.44 an hour
Required: Associate's degree or higher in Health Information Management
Intermediate to advanced proficiency in Microsoft applications (Word, Excel and Access), database management, and document preparation
REPORTS TO POSITION: Manager, Utilization Review
Required: Minimum 2 years’ experience in similar hospital related position with utilization experience preferred
Strong team working and collaborative skills
Strong analytical, problem solving and decision making skills
Utilization Review Specialist Sr
By BayCare At , Riverview, Fl
Preferred experience includes Critical Care or Emergency Nursing RN.
Written and verbal communication skills
Knowledge of regulatory standards appropriate to position
Computer skills appropriate to position
Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials.
401k match and additional yearly contribution
Utilization Review Specialist Jobs
By Medical Center Hospital At , Odessa, 79761, Tx

Holds a current Texas license as a Registered Nurse.

Utilization Review Coordinator Jobs
By BENEFIT MARKETING ALLIES CORP. At , Austin, 78701, Tx

Position Description: ROLE AND RESPONSIBILITIES Communication with Providers regarding Pre-Authorization Requests. Provider Outreach Calls to retrieve Medical Records. Maintaining HIPAA Compliant ...

Remote Inpatient Review Clinician Rn - Texas Only
By Molina Healthcare At , , Tx $26.41 - $51.49 an hour

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees:

Utilization Management Rn Jobs
By Boston Children's Hospital At , Boston, 02115, Ma
Minimum 3-5 years of related Case Management or clinical experience.
Connecting with UM Case Manager on the concurrent side for any questions of consistency.
Conducting proactive education on the importance of level of care/patient class
Leading physician education efforts to inform level of care decisions
A BSN is required, a Master’s in a related Healthcare field or certification is a plus.
The Case Manager will be responsible for:
Utilization Management Rn Jobs
By Piedmont Healthcare At , Atlanta, Ga

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:

Forbes named Piedmont one of Georgia’s 10 best employers and the highest-ranked healthcare provider.

Rn Utilization Management Reviewer
By Commonwealth Care Alliance At , Boston, 02108, 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 Nurse Jobs
By Methodist McKinney Hospital At , Mckinney, 75070, Tx
Uses knowledge of the nursing process and pathophysiology to interpret the needs or requirements of patients
Identifies, documents and communicates potential quality assurance or risk management issues as appropriate.
Uses knowledge of nursing process and pathophysiology to anticipate discharge needs.
Licensure as a registered nurse required.
Performs initial, concurrent, discharge and retrospective reviews.
Uses evidence-based medical guidelines to determine the medical appropriateness of inpatient and outpatient services