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Nurse Utilization Review jobs

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CASE MANAGER/UTILIZATION REVIEW

Bachelor's degree in healthcare or related field; BSN preferred. Licensed as a Registered Nurse in the State of Illinois. Five years recent clinical experience in a hospital setting, or four years recent clinical experience. Utili...

CompanySaint Anthony Hospital
AddressChicago, IL
CategoryEducation/Training
Salary$70.9K - $89.7K a year
Job typeFull-time
Date Posted 2 months ago See detail

Case Manager/Utilization Review

Saint Anthony Hospital

Chicago, IL

$70.9K - $89.7K a year

Bachelor's degree in healthcare or related field; BSN preferred. Licensed as a Registered Nurse in the State of Illinois. Five years recent clinical experience in a hospital setting, or four years recent clinical experience. Utili...

2 months ago seen See more...

Utilization Review RN - Remote in TX - Contract

Hireops Staffing, Llc

Dallas, TX

$40 an hour

This position is fully remote, however, you must reside in the State of TexasThe position is a contract for about 6 months.RN working in the insurance or managed care industry using medically accepted criteria to validate the medi...

2 months ago seen See more...

Utilization Review Case Manager - FT Days

Torrance Memorial Medical Center

Torrance, CA

$53.40 - $82.22 an hour

Tracks avoidable days....

2 months ago seen See more...

Registered Nurse (RN), Utilization Management - Adolescent Psych - PRN - Now Hiring

Denver Health

Denver, CO

$34.45 - $51.68 per hour

Works closely with other DHHA staff members including providers, nursing, insurance personnel, scheduling staff, staff in other departments.. (20%). Participates in care planning and discharge planning with the staff, providers an...

4 weeks ago seen See more...

Onsite/Remote- Sr Utilization Management Nurse RN Onsite or Remote

Optum

Boston, MA

$90.6K - $115K a year

Audit entire medical record for accuracy of the coding on the MMQ to support payment to the nursing facility. Answer patient questions regarding care (medication, treatment) and benefits. Discuss Patient Care specifics with peers...

a month ago seen See more...

Utilization Management Nurse Consultant

Cvs Health

Trenton, NJ

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.. Gathers clinical informat...

a month ago seen See more...

Physician Review/Utilization Review Physician

Vivo Healthstaff

San Diego, CA

M.D. Degree. License to practice in California must be in progress prior to the start date. Five years experience as a practicing primary care physician with knowledge of managed care and the process for prior authorization review...

a month ago seen See more...

Associate Director, Utilization Management Nursing - VA Medicaid

Humana

Virginia, United States

$102,200 - $128,000 a year

Serves as a liaison between Humana and the Commonwealth regarding prior authorization reviews, prepayment retrospective reviews, and any additional Utilization Management functions. Coordinates with the Clinical Leadership team to...

a month ago seen See more...

Utilization Management Reviewer I

Crawford & Company

United States

$75.3K - $95.3K a year

Uses clinical RN or RPT training and knowledge to render authorization decisions of medical necessity of requested medical treatment. Analyzes medical information and applies clinical knowledge and established criterion to facilit...

a month ago seen See more...

Utilization Management Nurse

One Senior Care

Erie, PA

9 Paid Holidays. 3 Weeks and 1 Day of Paid Time Off Accrued from the Date of Hire for Full-Time Employees. Annual Pay increases for Performance. Medical, Dental, & Vision. Free Life and AD&D Insurance Plan. Health Savings and Flex...

a month ago seen See more...

Registered Nurse (RN) - Utilization Management (Remote)

Uva Health

Charlottesville, VA

$71,988.80 - $115,190.40 a year

They collaborate with physicians and other members of the healthcare team to promote and adhere to regulatory compliance. All Utilization Management activities are performed in accordance with the mission vision and values of UVA...

a month ago seen See more...

Utilization Management LVN Nurse - Remote

Conifer Value

Frisco, TX

$27.30 - $40.95 an hour

Responsible for providing timely referral determination by accurate:Usage of the Milliman Care Guidelines.Identification of referrals to the medical director for review.Appropriate letter language (i.e. denials).Appropriate sele...

a month ago seen See more...

Utilization Management Registered Nurse

Wexford Health

Sylvania, PA

Work with patients and providers for the patients best interests by helping to ensure appropriate care and maximizing clients medical benefits; Review clinical information provided by the Hospital Utilization Management Departm...

a month ago seen See more...

Utilization Management Nurse

Solis Health Plans

Miami, FL

Conduct concurrent and retrospective utilization review for inpatient, observation or SNF services. Conducts clinical reviews of proposed services against appropriate criteria/guidelines to determine medical necessity, benefit eli...

a month ago seen See more...

RN Utilization Management Nurse - Remote in OR

Unitedhealth Group

Portland, OR

Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer. Perform all function...

2 months ago seen See more...

Utilization Management Clinical Registered Nurse (RN) - Clinic

Texas Children's Hospital

Bellaire, TX

In addition, discharge planning and provider education are major components of this process.Think you've got what it takes?Responsibilities* Analyze submitted information including clinical assessments, treatment plan, regulatory...

2 months ago seen See more...

Care Review Processor with Utilization Review/Managed Care Exp. (REMOTE - CA)

Omg Technology

Long Beach, CA

Provide computer entries of authorization requests/provider inquiries by phone, mail, or fax. Including: Verify member eligibility and benefits. Determine provider contracting status and appropriateness. Determine diagnosis and tr...

2 months ago seen See more...

Sr Utilization Management Nurse RN Onsite/Remote- MA

Optum

Boston, MA

$93.3K - $118K a year

Audit entire medical record for accuracy of the coding on the MMQ to support payment to the nursing facility. Answer patient questions regarding care (medication, treatment) and benefits. Discuss Patient Care specifics with peers...

2 months ago seen See more...

Behavioral Health Utilization Management Nurse

United Claim Solutions Llc

Remote

$60.5K - $76.6K a year

Conduct timely reviews of UM activities, including prospective, concurrent, and retrospective reviews and apply to summary plan documents or other resources related to the request. Collaborate with appropriate parties to apply the...

2 months ago seen See more...

Nurse Manager Utilization Management

Kaiser Permanente

South San Francisco, CA

Manages the operations of 24-hour departments that may be at multiple locations. Ensures Assistants and staff provide the highest quality of care and are in compliance with the Nursing Practice Act, The Joint Commission, federal,...

2 months ago seen See more...

Nurse Manager Utilization Management - Newark, United States - Kaiser

Kaiser

United States

Manages the operations of 24-hour departments that may be at multiple locations. Ensures Assistants and staff provide the highest quality of care and are in compliance with the Nursing Practice Act, The Joint Commission, federal,...

2 months ago seen See more...

Utilization Management Nurse RN

Optum

Bangor, ME

$58,300 - $114,300 a year

Validates authorization for all procedure / bedded patients UM pre-admission. Ensuring acquisition of pre-certification authorization, urgent/emergent authorizations, continued stay authorizations, and authorizations for post-acut...

2 months ago seen See more...

Utilization Management Nurse Consultant

Cvs Health

Sacramento, CA

$29.50 - $63.75 an hour

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical informati...

2 months ago seen See more...

Utilization Management Nurse

Cottingham & Butler

Dubuque, IA

$61.4K - $77.8K a year

We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys making a difference for patients, but that and prefers working in a professional office setting with daytime office hours and week...

2 months ago seen See more...

Utilization Management Nurse 2

Humana

Boise, ID

The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge an...

2 months ago seen See more...

Utilization Management Nurse Consultant

Cvs Health

Charleston, WV

$26.01 - $56.13 an hour

Must have active, current and unrestricted RN licensure in state of residence. 3+ years of clinical experience. Position requires proficiency with computer skills which includes navigating multiple systems. Ability to work in a fa...

2 months ago seen See more...

ISNP Utilization Management Nurse

Longevity Health Plan

United States

$79,000 - $96,000 a year

Receives requests for authorization of services, including inpatient hospital admissions, outpatient and/or inpatient elective surgery, and referrals for specialty physician consultation with non participating physician offices....

2 months ago seen See more...

CarePlus - Weekend Utilization Management Nurse, RN - Remote- Florida

Humana

Lorida, FL

Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to re...

2 months ago seen See more...

Utilization Management Nurse Consultant Afternoon Shift

Cvs Health

Columbus, OH

$29.10 - $62.31 an hour

Weekend/holiday coverage will occasionally be required. This candidate will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Utilizes clinical experience an...

2 months ago seen See more...

TPA Utilization Nurse

Usi Holdings Corporation

Braintree, MA

$75,000 - $85,000 a year

Review complex workers compensation medical treatment requests to ensure accordance with evidence based medical treatment guidelines, which are generally recognized by the national medical community and are scientifically based. R...

2 months ago seen See more...

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What are the top cities open Nurse Utilization Review jobs?

There are open Nurse Utilization Review jobs in several cities including Santa Rosa, Overland Park, Spencer, New Bern, Grand Junction, Irving, Saint Paul,

What companies are hiring for Nurse Utilization Review jobs?

The top companies hiring now for Nurse Utilization Review jobs are CarolinaEast Health System, Christus Health, DOCS Management Services, HealthBPM, LifeBridge Health, Netsmart, Netsmart Technologies, TLC Nursing, UST - 3.7, Zenex Partners,

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