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Utilization Review Nurses Our client, a Medicare Advantage Health Maintenance Organization (HMO), is committed to offering comprehensive, affordable, and valuable healthcare to Medicare beneficiaries. They are seeking two Utilization Review nurses for a 3 month assignment in their downtown Manhattan offices.. Job Requirements: - UM/UR experience necessary - Milliman guidelines - Managed care and Medicare experience preferred - RN license, New York State

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Review medical records evaluate level of care interact with MD s Case Managers discharge planning...Must be active RN Position Description Collect case specific member information review and certify the...Review each case and determine the most appropriate services the...

Document case review findings actions and outcomes in accordance with policy...

3 30p 1 30p 10 00p Collect case specific member information review and certify the...Review each case and determine the most appropriate services the...Review Early initiation of discharge coordination Analyze case specific patient information...

Claims Auditing Nurse Medical Record Review Nurse Utilization Review RN If you are a Registered...Medical Record Review Nurse Utilization Review Registered Nurse Medical Claims Auditing Nurse...fit for the Medical Record Review Nurse Utilization Review Regist...

Review medical records evaluate level of care interact with physicians case managers discharge planning...Collect case specific member information review and certify the...Review each case and determine the most appropriate services the...

criteria to Physician Reviewer Refer cases to case management Research clinical questions from employers members...

in California for Utilization Management Quality Management Case Management Workers Comp Audit Discharge Planning other...

Click Here to Flag This Job Jobs by - Career Test - Resume Distribution - Career Magazines - Resume Writing Tips - Career Advice - Live! - Salary Tools Search For A New Job Job Category All categories within Zip Code Architecture & Engineering Arts, Design, Entertainment, Media Bldg/Grounds Maintenance & Cleaning Business & Financial Operations Community & Social Services Computer & Mathematical Construction & Extraction Education, Training

Click Here to Flag This Job Jobs by - Career Test - Resume Distribution - Career Magazines - Resume Writing Tips - Career Advice - Live! - Salary Tools Search For A New Job Job Category All categories within Zip Code Architecture & Engineering Arts, Design, Entertainment, Media Bldg/Grounds Maintenance & Cleaning Business & Financial Operations Community & Social Services Computer & Mathematical Construction & Extraction Education, Training

The temporary Home Care Utilization Review Nurse will conduct clinical reviews of pediatric and young adult members for all inpatient stays, homecare, outpatient rehabilitative therapy, durable medical equipment and long term care services based on standardized criteria. Responsible for both the management of resources and the achievement of desired outcomes for members with ongoing communication to the Director of Care Management and Utilization Management, the Medical Director and staff for the development

Ready to make a change from traditional nursing to a job that does not require weekends and holidays and... allows you to use your brain not your muscle! The Monroe Plan for Medical Care(MPMC) is actively seeking a Licensed Practical Nurse for a Utilization Review Nurse opening. Under the supervision of a Registered Nurse, the UM LPN performs initial clinical review for medical appropriateness of health care services. The Utilization Review Nurse seeks to enhance our member's access to care and services while

care when allowed by state jurisdiction Refers case to a review physician when the treatment...calls made and received in regard to case communication and all demographic and service group...

Review medical records evaluate level of care interact with MD s Case Managers discharge planning...

2 years demonstrated experience in utilization review case management and discharge planning in an Acute Care setting...

Review Department Behavioral Health Services Description Identifies case management needs in collaboration with the patient...

May perform review of cases to identify referral for case management...

Review medical records evaluate level of care interact with MD s Case Managers discharge planning...

2 years in experience in utilization review case management or managed care Previous Precert experience...

2 years in experience in utilization review case management or managed care Previous Precert experience...

who has experience reviewing medical documents and case management Responsible for performing medical reviews evaluate...

communication flow with internal Disease Review Complex Case Management or Social Services staff to facilitate... Participate in case conferences clinical in services and other educational opportunities... Experience in utilization review case management or disease management required Two years...

and psychosocial support Promoting customer service and case satisfaction to achieve established goals and objectives...

NURSE UTILIZATION REVIEW AND DISCHARGE PLANNING CASE MANAGER OPEN Closing Date Time Continuous Salary...Job Title CHARGE NURSE UTILIZATION REVIEW AND DISCHARGE PLANNING...

Job Purpose/Duties: The temporary Home Care Utilization Review Nurse will conduct clinical reviews of pediatric and young adult members for all inpatient stays, homecare, outpatient rehabilitative therapy, durable medical equipment and long term care services based on standardized criteria. Responsible for both the management of resources and the achievement of desired outcomes for members with ongoing communication to the Director of Care Management and Utilization Management, the Medical Director and staff

Judge Medical staffing is currently seeking an experience RN for a utilization review position with one of our top clients in Phoenix, AZ. This is a temporary position. The UR nurse will be perform medical reviews and function as a member of a self-directed team to meet specific individual and team performance metrics. Must be familiar with Milliman or Interqual criteria. Must have an active RN license in Arizona.

Present cases at Medical Director rounds and case conferences Communicate to enhance effectiveness of medical...

care when allowed by state jurisdiction Refers case to a review physician when the treatment...calls made and received in regard to case communication and all demographic and service group...

is currently looking for two experienced Nurse Case Managers with Worker s Compensation for a...setting with Med Surge Review files for Case management and Litigation review for Workers Comp...

Clinical Experience Case Management Experience a Plus Familiar with MS Word MS Excel and Outlook Excellent Communication Skills...

productivity metrics to meet Position Description Collect case specific member information review and certify the... Review each case and determine the most appropriate services the...Review Early initiation of discharge coordination Analyze case specific patient information...

Duties will include Review of medical records evaluate level of care interact with MD s Case Managers discharge planning...Collect case information review and certify the medical necessity of inpatient and outpatient services...Review Early initiation of discharge coordination Analyze case specific patient information...

workmans compensation nurse manager nurse supervisor case manager case management telephonic nurse telephonic...telephonic case manger TCM FCM field case manager dept manager department manager supervisor nurse...worker workers compensation return to work Case Manager Supervisor Care Manager Care Management Supervisor...

Utilization Review RN Utilization Review RN needed immediately! 12 week assignment!! Pay for this opportunity is $28.00/hr Favorite Healthcare Staffing is a national Joint Commission certified provider of supplemental and travel healthcare staff with over 26 years in business and more than 50 branches nationwide. We are currently looking for a Utilization Review RN interested in contract or per diem opportunities in the Warwick, RI metro area. Benefits - Flexible Working Hours and Days -

Review medical records evaluate level of care interact with MD s Case Managers discharge planning...Must be active RN Position Description Collect case specific member information review and certify the... Review each case and determine the most appropriate services the...

with providers Referring patients to disease or case management programs Utilization Review Nurse Job requirements...the Utilization Review Nurse will include Performing case reviews received via fax telephonic Ensuring that...of clinical practice and 3 years of case management and or utilization review experience Managed...

Homecare Utilization Review (#7900) This utilization review nurse works part-time (8 hours/day, 2-3 days/week) and is responsible for the clinical review of children and youth who are receiving home care services. Reviews are conducted telephonically from the health plan offices, but the RN may need to cover in-person UR at times. Pediatric experience required, home care and/or managed care experience preferred. Experience with Interqual required.. Job Requirements: REQUIRED - Active and unrestricted

Masters in related field preferred Certified Case Manager CCM preferred Minimum of five years...or Masters in related field preferred Certified...

Title: Utilization Review Nurse I/II (2 positions) Department: Utilization Management Operating Team: Health Care Affairs Position Resides at: Syracuse Summary: The Medical Care Coordinator is responsible for coordinating, integrating, and monitoring the use of medical and health care services for members. Qualifications: Registered Nurse with current license. Bachelor's degree preferred. Minimum of three years of clinical nursing background required. A minimum of 1 year's recent Utilization Management or Home

Fax http www nurseresolutions com Indianapolis nurse rn registered nurse utilization review prior authorization...

Find yourself among the best. At The University of Kansas Hospital, nurses deliver world-class patient care in an environment where opinions are respected, professionalism is rewarded and teamwork is valued. Nurses come here to practice at the leading edge of their profession, to be an integral part of medical breakthroughs, and to handle complex cases that community hospitals rarely if ever see. In addition to being the best place to work, the hospital offers very competitive wages and an outstanding benefit

Thorek Memorial Hospital located in the Chicago Lakeview neighborhood is currently seeking an experienced Utilization Review Nurse. GENERAL SUMMARY: Timely and appropriate discharges through assessment of the patient's post-discharge needs and the provision of services necessary to meet those needs. Functions as a member of a multidisciplinary team that promotes timely interventions. Nurses determine the medical necessity of admissions and the need for continued stay through a thorough knowledge of state

Certification in Case Management or Certified Professional in Healthcare Quality CPHQ encouraged...Additional utilization management quality management or case management experience preferred...

RN, UTILIZATION REVIEW AmeriStaff Nursing seeks RN to manage occupational W/C claims on-site in Auburn Hills. Must have experience in industrial claims management, including cost projection and return to work programs. Excellent assessment and communication skills are a must. Candidate will implement health and wellness program. Full time with excellent compensation. Send resume to or Fax to 248-288-5713 Attn: Hiring Manager. Job Requirements: See above

Position Purpose: Perform utilization review for outpatient services Knowledge/Experience: At least two years clinical nursing experience. Managed care experience preferred. PC literate and familiar with Microsoft Office applications (Outlook, Word, Excel). Competencies: Knowledge Worker: Integrity, Flexibility, Communication, Critical Thinking, Customer Focus, Decision Making, Planning and Organizing, Building Strategic Working Relationships, Technical and Professional Knowledge ..

evaluating Monitors and analyzes daily workers compensation case management production to ensure the proper handling...preferred Significant experience 3 5 years in case management managed care or utilization review Thorough...

1 30p 10 00p Position Description Collect case specific member information review and certify the... Review each case and determine the most appropriate services the...Review Early initiation of discharge coordination Analyze case specific patient information...

management company who provides services such as case management disease management health and wellness and...of cases MD reviews chart reviews audits case management referrals Maintains current information on hospital...

management company who provides services such as case management disease management health and wellness and...of cases MD reviews chart reviews audits case management referrals Maintains current information on hospital...