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CLINICAL REVIEW NURSE I (US)

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...

CompanyElevance Health
AddressWaukesha, WI
CategoryRetail
Date Posted a week ago See detail

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...

a week ago seen See more...

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...

2 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...

2 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...

2 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...

2 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...

2 weeks 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...

2 weeks 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...

2 weeks 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...

2 weeks 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...

3 weeks 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/...

3 weeks 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...

3 weeks 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...

3 weeks 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...

3 weeks 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...

3 weeks 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...

3 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...

6 days 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...

6 days 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...

7 days 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...

7 days 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...

4 weeks 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...

4 weeks 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...

4 weeks 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...

4 weeks 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...

4 weeks 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...

4 weeks ago seen See more...

Clinical Review Nurse - Concurrent Review

Fidelis Care

Getzville, NY

$25.00 - $44.85 an hour

Performs Concurrent Reviews of member for appropriate care and setting to determine overall health and appropriate level of care Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of sta...

4 weeks ago seen See more...

Prior Authorization/Utilization Review Nurse

Indian Health Care Resource Center

Tulsa, OK

$65,000 a year

JOB SUMMARYThe Prior Authorization/Utilization Review Nurse is responsible for carefully recording information regarding patient care on the back end of the clinic and doctor's office visits in hopes of keeping healthcare costs lo...

4 weeks ago seen See more...

Utilization Management Denial Review Nurse - LVN

Ucla Health

Los Angeles, CA

$61,400 - $121,400 a year

DescriptionQualificationsWere seeking an exceptionally gifted, self-motivated leader with: * Current CA LVN licensure required * Two or more years of utilization review/Utilization Management experience in an HMO, MSO, IPA, or he...

4 weeks ago seen See more...

Utilization Review Nurse

Veritas Allies, Llc

Remote

$65.7K - $83.2K a year

401(k). Health insurance. 8 hour shift. Day shift. Monday to Friday. Utilization review: 1 year (Required). RN (Required)....

a month ago seen See more...

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People who searched for Review Nurse jobs also searched for Nursing Supervisor, Registered Nurse Virtual, Private Duty Registered Nurse, Nurses Aide, Clinical Nurse Manager, Nursing Home, Registered Nurse Home Health, Nurse Extern, Nurse Team Lead, Nursing Program Director, Triage Registered Nurse, Practical Nurse, Register Nurse, Registered Nurse Inpatient, Critical Care Nurse, . If you're getting few results, try a more general search term. If you're getting irrelevant result, try a more narrow and specific term.

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What are the top cities open Review Nurse jobs?

There are open Review Nurse jobs in several cities including Atlanta, New York, Olin, Youngstown, Garland, Bakersfield, Leonia, Kirkland, Medford, Monterey Park, South San Francisco, Albuquerque, Sun Valley, Albany, Plano,

What companies are hiring for Review Nurse jobs?

The top companies hiring now for Review Nurse jobs are Albany Medical Center, CERiS, CharLee Corporation, Department of Veteran's Affairs, Ethos Risk Services - 3.0, Generations Behavioral Health, Health Plan of San Mateo - 3.4, HireOps Staffing, LLC, HireOps Staffing, LLC, HireOps Staffing, LLC - 5.0, Huntsville Memorial Hospital, Integrity Billing Company, Johns Hopkins Health System, Long Tail Health Solutions Inc, MedMetrix PHL,

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