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Preservice Review Nurse jobs

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PRESERVICE REVIEW NURSE RN - REMOTE

Generally work is self-directed and not prescribed. Works with less structured, more complex issues. Serves as a resource to others. Assesses and interprets customer needs and requirements. Identifies solutions to non-standard req...

CompanyUnitedhealth Group
AddressCypress, CA
CategoryEducation/Training
Job typeFull-Time
Date Posted 4 weeks ago See detail

Preservice Review Nurse RN - Remote

Unitedhealth Group

Cypress, CA

Generally work is self-directed and not prescribed. Works with less structured, more complex issues. Serves as a resource to others. Assesses and interprets customer needs and requirements. Identifies solutions to non-standard req...

4 weeks ago seen See more...

LPN Preservice Review Nurse - PST - Remote

Optum

Seattle, WA

$19.47 - $38.08 an hour

Understand and follow standardized processes for managing add or change requests and implementing requests in the letter generation system. Create and review denial letters to determine compliance with contractual and regulatory r...

a month ago seen See more...

Nurse Reviewer I - Chicago, United States - Elevance Health

Elevance Health

United States

Type: Full time. Date Posted: Apr 17, 202. Anticipated End Date: May 17, 2024. Reference: JR113707. Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical neces...

3 days ago seen See more...

Registered Nurse - Utilization Review

Ascension

Jacksonville, FL

Department: Utilization Management Schedule: Part Time, Every Saturday and Sunday, 7am - 7pm Hospital: Ascension St. Vincents Riverside Location: Jacksonville, FL Review admissions and service requests within assigned unit for pr...

a week ago seen See more...

Clinical Review Nurse - Prior Authorization

Bcforward

Indianapolis, IN

Clinical Review Nurse - Prior AuthorizationBC Forward is looking for Clinical Review Nurse - Prior Authorization (Remote Work) Position Title: Clinical Review Nurse - Prior Authorization (Remote Work) Locations: Remote IN (Local t...

2 weeks ago seen See more...

REMOTE Registered Nurse (Utilization Review/MEDCOMPASS EXP REQUIRED)

A-Line Staffing Solutions

Atlanta, GA

Start Date: ASAP/TBD. Potential for Direct Hire?: YTBD. $36.21 p/hr, paid biweekly. Benefits are available after 90 days and include health, optical, dental, life, and short-term disability insurance. To be eligible for benefits y...

a week ago seen See more...

Clinical Review Nurse I (US)

Elevance Health

Waukesha, WI

Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials. . Requires AS in nursing and minimum of 1 year of clinical experience; or any combination of...

4 weeks ago seen See more...

Registered Nurse OASIS/Utilization Review Home Health - Lehi, UT

Impact Healthcare Llc

Lehi, UT

Taking inbound calls to review clinical assessments completed upon admission, recertification, evaluation, change of condition, and transfers. Review key OASIS data items and provide education on accurate data collection, utilizat...

3 weeks ago seen See more...

Registered Nurse Clinical Reviewer PRN

Corpus Christi Medical Center Bay Area

Corpus Christi, TX

Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transporta...

3 weeks ago seen See more...

Nurse Reviewer I (NCLEX)

Elevance Health

San Juan, PR

Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. Conducts initial medical necessity r...

3 weeks ago seen See more...

Registered Nurse-Review Analys

Veerteq Solutions Inc.

Detroit, MI

Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service and level of care, including appeal...

3 weeks ago seen See more...

Clinical/Utilization Review Nurse

Aspirion Health Resources Llc

Remote

From $68,000 a year

Manages complex and robust queue according to Aspirion and client needs. Queue size varies weekly. Reviews insurance denials, including but not limited to, medical necessity denials, patient status denials (i.e., Inpatient vs. Out...

4 weeks ago seen See more...

Utilization Review Nurse (RN)

Managed Resources, Inc

Remote

$38 - $42 an hour

401(k). 401(k) matching. Dental insurance. Disability insurance. Employee assistance program. Flexible spending account. Health insurance. Life insurance. Paid time off. Referral program. Vision insurance. Pet Insurance. Monthly I...

4 weeks ago seen See more...

Fraud and Abuse Review Nurse

Gainwell Technologies Llc

Kansas, United States

$61,500 - $87,900 a year

Ability to interact with customers and agencies to interpret Medicaid coverage. Strong written/oral communication skills. Ability to read, understands, and interprets complex regulatory and procedural documents. Extensive PC skill...

4 weeks ago seen See more...

Concurrent Review Nurse (Active CA RN License)

Zempleo Inc

California, United States

$55 - $62 an hour

100% remote role. Work Schedule: 8:00am 5:00pm Pacific Time. Ensures proper procedure and diagnosis codes are reviewed for submitted procedures/claims. Solicits support from SME's, leads, and managers as appropriate. Triages and...

a month ago seen See more...

Utilization Review Nurse

American Health Plans Llc

Franklin, TN

$57.9K - $73.4K a year

Affordable Medical/Dental/Vision insurance options. Generous paid time-off program and paid holidays for full time staff. TeleDoc 24/7/365 access to doctors. Optional short- and long-term disability plans. Employee Assistance Plan...

a month ago seen See more...

Quality Review Nurse

Medstar Health

Maryland, United States

Contributes to the achievement of established goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Completes annual Code of Conduct, Compliance, and other mandatory training...

a month ago seen See more...

OASIS/Clinical Record Review Nurse

Safrest

New York, NY

Monday through Friday (hybrid inBrooklyn). Benefits: PTO, 401(k) with a 5% match, FSA, and more! Prospectively reviews all OASIS assessments to ensure appropriateness, completeness, and compliance with federal and state regulatio...

a month ago seen See more...

Utilization Review Nurse

Theoria Medical

Novi, MI

$80,000 - $85,000 a year

Monday-Friday 8am to 5pm. Remote. This is a full-time, remote position. Utilization management. Clinical quality management. Care coordination/Case management. ACO Alignment activities. Review patient medical records and documenta...

a month ago seen See more...

Concurrent Review Nurse (RN) Part-Time (.5)

Central California Alliance For Health

Merced, CA

Performing concurrent or post-service (retrospective) review of acute in-patient care services using established criteria. Participating in the Utilization Management (UM) Care Programs. Knowledge of:. Utilization Management, and/...

a month ago seen See more...

Professional Review Nurse

Corvel

Remote - Oregon, United States

Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and or direct reporting manager. Collect supporting data and analyze information to make decisions regardi...

a month ago seen See more...

Utilization Review Nurse- PRN

Netsmart Technologies

Remote

$77.6K - $98.3K a year

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 documen...

a month ago seen See more...

LVN - Inpatient Utilization Review Nurse - SRS Copley - Days - FT

Sharp Healthcare

San Diego, CA

$74.8K - $94.7K a year

3 Years experience in the acute patient care, Home Health and/or SNF setting. 2 Years Utilization/Case Management experience, preferably in a Managed Care setting. California Licensed Vocational Nurse (LVN) - CA Board of Vocationa...

a month ago seen See more...

Utilization Review Nurse (40 Hour)

State Of Connecticut

Hartford, CT

Work Unit: Inpatient Unit. Work Schedule: Monday - Friday. Work Hours: Full-time, 40 Hours per week. Work Shift: First shift, 8:00 a.m. - 4:30 p.m. Location: 500 Vine St, Hartford, CT. A Platinum Healthcare Plan, the nation's best...

a month ago seen See more...

Utilization Review Nurse - Case Management

Kern Medical

Bakersfield, CA

$41.32 - $65.10 an hour

New Hire Bonus: $6,000.00. New Hire Premium: +6% of base rate of pay, matched up to 6% if contributed to Deferred Compensation Plan. Shift Differential Pay: 10% of base pay for hours worked from 7:00 PM to 7:30 AM, with two (2) ho...

a month ago seen See more...

Clinical Review Nurse

Novitas

United States

$51.1K - $64.7K a year

Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire. Short- and long-term disability benefits. 401(k) plan with company match and immediate vesting. Free teleh...

a month ago seen See more...

UTILIZATION REVIEW NURSE - CASE MANAGEMENT

North Oaks Health System

Hammond, LA

Physical Effort RequiredStrength: SedentaryPush: occasionallyPull: occasionallyCarry: occasionallyLift: occasionallySit: frequentlyStand: frequentlyWalk: frequentlyResponsibilities:Monitors and facilitates initial and continued st...

a month ago seen See more...

Concurrent Review Nurse

San Joaquin County Health Commission

Modesto, CA

$90,825 - $130,805 a year

Confirms member care plan with provider. Identifies care issues and collaborates with provider to resolve; escalates as necessary. Makes timely and appropriate recommendations regarding transfers, determination of level of care an...

a month ago seen See more...

Utilization Review Nurse

Hamaspik Choice

Spring Valley, NY

$39 - $40 an hour

Temporarily due to COVID-19. Dental insurance. Health insurance. Life insurance. Paid time off. Vision insurance. Monday to Friday. Clinical Review: 1 year (Required). RN (Required). Spring Valley, NY: Relocate before starting wor...

a month ago seen See more...

Utilization Review Nurse (RN)

Tidelands Health

Murrells Inlet, SC

$59.9K - $75.9K a year

Associate Degree in Nursing, required; Bachelor of Science Degree in Nursing, preferred Current and in good standing SC RN license with SCLLR. Minimum two years RN Utilization Review with Interchange Health, InterQual tool experie...

2 months ago seen See more...

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There are open Preservice Review Nurse jobs in several cities including Seattle, Greensboro, Downers Grove, Phoenix, Brentwood, Boston, Memphis, Tampa, Nashville,

What companies are hiring for Preservice Review Nurse jobs?

The top companies hiring now for Preservice Review Nurse jobs are Optum, UnitedHealth Group,

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