UTILIZATION REVIEW NURSE (FULL TIME). Active licensure to practice as a Registered Nurse in Washington State. ...
The Utilization Review Care Manager Lead collaborates with the Director of Utilization Management and Utilization Management Medical Director to oversee the day to day utilization management function of a team or teams of clinicians ensuring the accurate and timely prior authorization of designated ...
Responsible for utilization review work for emergency admissions and continued stay reviews. Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual or MCG criteria. Enter clinical review information into system for transmission to insur...
HeiTech Services is seeking Full-time Registered Nurses to staff a Nurse Advice Line call center 24x7/365 (primarily inbound) to work daytime, evening and overnight shifts. Registered Nurse for Work from Home Evening and Weekend Telehealth. The Full-Time Registered Nurse is responsible for providing...
Oversees an integrated Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review, and/or other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time...
Registered Nurse / Med/Surg (Tier 3) / VA Reviewer. Greenlife Healthcare Staffing is currently seeking a Med Surg Registered Nurse - VA Reviewer to fill an opening with a Non-profit organization. Registered Nurse / Med/Surg (Tier 3) / VA Reviewer. Registered Nurse / Med/Surg (Tier 3) / VA Reviewer. ...
Within three (3) years of hire as a case manager, the case manager will become CCM certified. For this position, Nurse Case Manager Senior Analyst, through the case management process, will:. Establishes a documented patient centric case management plan involving all appropriate parties (client, phy...
Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost e...
Our ideal case manager is caring, compassionate, solution-oriented and enthusiastic about providing an outstanding experience for Devoted Health’s members. Proven success and enjoyment in building relationships with a variety of stakeholders, such as care managers at hospitals and care coordinators ...
Strategic Staffing Solutions is currently looking for an RN Case Manager for a contract opportunity with one of our largest healthcare clients!. The Care Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member’s heal...
Registered Nurse / Wound Care (Tier 3) / VA Reviewer. Greenlife Healthcare Staffing is currently seeking a Wound Care Registered Nurse - VA Reviewer to fill an opening with a Non-profit organization. ...
The Good Samaritan Society is seeking to hire a compassionate and adaptable Registered Nurse to join our team as a Travel RN This opportunity allows a RN to travel locally by working in various GSS locations within a -mile radius from home address providing care with competitive pay, mileage reimbur...
A Triage Nurse is a professional registered nurse with oncology-specific clinical knowledge that offers individualized care and clinical guidanceto patients, families, and caregivers to assist with ongoing healthcare needs. Registered Nurse multistate or Florida single state licensure required. With...
Are you a compassionate, self-motivated registered nurse with top-notch critical thinking and clinical skills? Seeking a challenging yet remote registered nurse position that keeps your abilities sharp?. Carenet Healthcare Services is seeking RNs (Registered Nurses) to join our team of talented prof...
Opportunity for US licensed RN to work in our Utilization Department conducting reviews for Prior Authorizations. While this is open to applicants nationwide, applicants should either already have an Illinois RN license or be willing to obtain one within 30 days of the start date and to work their s...
Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Performs concurrent reviews of member for appropriate care and setti...
Looking for a registered nurse position that is challenging, will keep your clinical skills sharp, but being doing so from the comfort of home. Compassion-driven, self-motivated, high-performing registered nurse. Carenet Healthcare Services is seeking RNs (Registered Nurses) to join our team of tale...
The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost-effective care. Provides utilization management, transition coordination, discharge planning and issuance of all appropriate autho...
DaVita Integrated Kidney Care (IKC) is looking for a Full-Time RN Case Manager (RN) to join us in. Registered Nurse (RN) Case Manager. Family resources, EAP counseling sessions, access Headspace®, backup child and elder care, maternity/paternity leave and more. Identify and address social determinan...
Are you a compassionate, self-motivated registered nurse with top-notch critical thinking and clinical skills? Seeking a challenging yet remote registered nurse position that keeps your abilities sharp?. The start date for this exciting registered nurse opportunity is. Carenet Healthcare Services is...
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team.Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.PRN - At Least 29 Hour...
The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, and case management as assigned. The Case Manager, Utilization Management is also responsible for efficient utilization of health services an...
Assesses and reviews complex concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Performs complex concurrent reviews of member fo...
CASE;RN, case manager, case management, care manager, CM, nurse, utilzation review, discharge planning, insurance, telephonic, medical coverage, CCM, inpatient, critical care, medsurg, ICU, remote, benefits, coordinate, medical records. Responsibilities of the Case Manager, RN:. Qualifications of th...
This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any state. Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies op...