Utilization Review Nurse - Hanover, MD

Summary/Position Objectives: · The Utilization Management (UM) Nurse is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to members. Utilizing evidence-based guidelines, regulatory requirements, and health plan crit ...

Job Type · Full-time · Description · Summary/Position Objectives: · The Utilization Management (UM) Nurse is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to members. Utilizing evidence-based guidelines, regulato ...

· Description · Summary/Position Objectives: · The Utilization Management (UM) Nurse is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to members. Utilizing evidence-based guidelines, regulatory requirements, and ...

· Full-time · Description · Summary/Position Objectives: · The Utilization Management (UM) Nurse is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to members. Utilizing evidence-based guidelines, regulatory requi ...

The Nurse Educator/Review Coordinator's primary role is to facilitate provider education related to the claim reviews performed under Task Order 3 for the BFCC-QIO contract. · ...

The Nurse Educator/Review Coordinator's primary role is to facilitate provider education related to the claim reviews performed under Task Order 3 for the BFCC-QIO contract. · Graduation from an accredited school of nursing and current licensure as Registered Nurse (RN) or accred ...

Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. · ...

We are seeking an Utilization Review Nurse to facilitate and coordinate programs in hospital inpatients, outpatients, families, community, and employees by providing evidence-based care based on the nursing process. · ...

Overview: · Johns Hopkins Intrastaff is the internal staffing agency for the Johns Hopkins Health System and partner hospitals, providing temporary support to a variety of Johns Hopkins locations. Our employees are the strength of our service. Intrastaff is unique because it's on ...

Make it happen at Hopkins As a member of Johns Hopkins Medicine, Johns Hopkins Howard County Medical Center is a 266-bed acute care facility that has been serving the community for nearly 40 years. We can offer the most advanced, innovative technology with the collaboration and t ...

This travel nurse RN position involves utilization review for 13 weeks at 40 hours per week with no call, holiday, or weekend shifts. · ...

This role combines clinical medical review and medical record abstraction responsibilities. The position handles day-to-day review of professional and institutional claims, provider appeals, and medical record abstraction to determine benefit eligibility and support claims proces ...

Purpose · Resp & Qualifications · The Clinical Medical Review Nurse handles day-to-day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjud ...

This role combines clinical medical review and medical record abstraction responsibilities. The position handles day-to-day review of professional and institutional claims, provider appeals, and medical record abstraction to determine benefit eligibility and support claims proces ...

Purpose · Resp & Qualifications · The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjud ...

We are seeking a Medical Review Nurse for long term contract position with our customer in the Maryland area.This position assists in determining acceptable medical risk to the organization by analyzing medical information of applicants for enrollment in specific policies. · ...

This role combines clinical medical review and medical record abstraction responsibilities.The position handles day-to-day review of professional and institutional claims, provider appeals, and medical record abstraction to determine benefit eligibility and support claims process ...

+This role combines clinical medical review and medical record abstraction responsibilities. · +Claims Review & Analysis (35%): Review and analyze professional and institutional claims using critical thinking, nursing judgment, and corporate/medical policies. · ...

This role combines clinical medical review and medical record abstraction responsibilities. The position handles day-to-day review of professional and institutional claims, provider appeals, and medical record abstraction to determine benefit eligibility and support claims proces ...

Join us to advance health access, elevate patient experiences, and contribute to a system that values bold ideas and community-centered care. · Competitive compensation (additional compensation such as overtime, shift differentials, premium pay, and bonuses may apply depending on ...