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The Utilization Review Nurse performs prospective and retrospective reviews for post-acute care services. Perform initial prior authorization review of post-acute care services applying guideline criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination.
Full-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Responsibilities The Utilization Review Nurse is responsible for determining the appropriateness of hospital admission; utilization of resources and medical necessity for continued stay; facilitates timely discharge; assures medical documentation accurately reflects the patient's severity of illness; provides appropriate interventions and discharge planning services to the patients and families in collaboration with Case Management.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Preferred: 3 years of experience as a Utilization Review Nurse in an acute care setting. The Utilization Review Nurse will work collaboratively and proactively with the medical staff, nursing staff, and other disciplines to support and achieve the goals of the collaborative care process.
ExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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The Utilization Review Nurse has a pivotal role in evaluating the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities according to the provisions of our benefits plan.
ExpandApply NowActive JobUpdated 19 days ago - UpvoteDownvoteShare Job
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Pioneers Medical Center Case Manager / Discharge Planner / Utilization Review, Registered Nurse (RN) is responsible for compliance with CMS Conditions of Participation including implementation and annual review of the Utilization Management Plan and coordination of the Utilization Management Committee (UMC.
$35 - $46 an hourExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Case Manager (RN) – Utilization Management – Weekend Incentive Program (WIP)Weekend Shift: Saturday & Sunday (Hours: 7pm-7am) Newark, DEChristiana Care Hospital currently recruiting a Registered Nurse (RN) for our Weekend Incentive Program (WIP) with experience in Utilization Management in an Acute Care Hospital Setting.
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The Utilization Management Nurse will work with ED providers to review medical necessity and collaborate for discharge planning, as appropriate. The Utilization Management Nurse will be responsible for ensuring the delivery of efficient and effective health care while evaluating the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provision of the applicable health benefits plan.
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The Utilization Management Nurse will work closely with ED providers to review medical necessity and collaborate for discharge planning, as appropriate. UTILIZATION MANAGEMENT: Performs admission and concurrent review to identify medical necessity, level of care and appropriateness of setting using established criteria and clinical guidelines within 24 hours of admission.
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Under the direction of the Director of Admissions & Director of Utilization Review, the Utilization Review Specialist will coordinate Medicaid Managed Care benefits and approvals for clients receiving behavioral healthcare services from Odyssey House’s Part 820 residential programs.
$70,000 a yearFull-timeExpandApply NowActive JobUpdated 27 days ago - UpvoteDownvoteShare Job
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Case management, utilization review, or discharge planning experience in an acute, rehabilitation, skilled nursing or outpatient setting is required. Mass General Brigham is seeking a per diem / prn nurse RN Case Management for a per diem / prn nursing job in East Sandwich, Massachusetts.
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Christiana Care Hospital currently recruiting a Registered Nurse (RN) for our Weekend Incentive Program (WIP) with experience in Utilization Management in an Acute Care Hospital Setting.
Full-timeExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Minimum of 3 years recent experience as a Registered Nurse in acute care, adult care setting. Performs admission and concurrent review to identify medical necessity, level of care and appropriateness of setting using established criteria and clinical guidelines within 24 hours of admission.
Full-timeExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Case Manager (RN) – Utilization Management – Weekend Incentive Program (WIP) Serves as a resource to nursing and ancillary staff, providing education on utilization review processes as needed.
ExpandApply NowActive JobUpdated 21 days ago - UpvoteDownvoteShare Job
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Notifies physician when patient does not meet criteria for acute care hospitalization, pursues documentation to justify continued stay within 24 hours. Reviews the admission assessment, collaborates with primary nurse and other health care providers to ensure a multidisciplinary plan-of-care is in place to meet identified patient care needs and desired outcomes.
ExpandApply NowActive JobUpdated 21 days ago - UpvoteDownvoteShare Job
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Provides On-call support for the Transfer Center to evaluate medical necessity and appropriateness when a request is obtained from an outside facility for patient transfer to Christiana Care.
ExpandApply NowActive JobUpdated 21 days ago
acute care nurse rn utilization review jobs Title: medical Company: Prisma Health in Missouri-city, Missouri
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