Utilization Management Review Nurse - Washington

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. · This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy.Nurse ...

We are hiring a Utilization Review Nurse to support our Utilization Review team by evaluating medical necessity requests and reviewing ongoing hospital stays. · ...

This role enables associates to work virtually full-time with maximum flexibility and autonomy. · ...

+This nurse will support our Utilization Review team by evaluating medical necessity requests and reviewing ongoing hospital stays to ensure services are clinically appropriate, cost-effective, and aligned with plan guidelines. · + ...

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partne ...

About this Job: eneral Summary of PositionConducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensur ...

We are seeking a licensed RN for a full-time salaried position in medical record review. The role involves coordinating case reviews with administrative staff and physician peer reviewers. · Collaborate telephonically and electronically with industry professionals. · Summarize an ...

Johns Hopkins Health Plans is the managed care and health services business of Johns Hopkins Medicine. We are seeking a Utilization Review Registered Nurse to work from home, monitor the appropriateness of care received by plan members in various settings, evaluate member benefit ...

Navigate and work within our proprietary electronic medical record system to evaluate and process patient health information to determine outcomes for various types of medical and specialty exams · Conduct a clinical review of a variety of examination documentation test results a ...

We are seeking an experienced Remote Quality Review Registered Nurse to join our team supporting military communities. · ...

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 ...

The Utilization Review Nurse is responsible for reviewing and evaluating clinical information and documentation. · Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations. · Evaluates documentation/information to ...

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 ...

Zimmerman Associates, Inc. (ZAI) seeks Licensed Practical Nurse Referral Reviewers for its contract with the Integrated Referral Management and Appointing Center (IRMAC). · ...

· 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 ...

As a Utilization Review Registered Nurse for Johns Hopkins Health Plans, you have the opportunity to use your clinical skills to make a difference in our members' lives. · ...

Job summary · Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. · ResponsibilitiesConducts admission concurrent and retrospective case reviews to meet hospital objecti ...

GQR Healthcare is seeking a travel nurse RN Utilization Review for a travel nursing job in Baltimore, Maryland. · Job Description & Requirements · Specialty: · Utilization Review · Discipline: · RN · Duration: · 13 weeks · 40 hours per week · Shift: · 8 hours, days · Employment T ...

This position involves reviewing Medicare Fee-for-Service claims to assess overpayments underpayments and proper payments as determined by Recovery Audit Contractors RACs.RVC Reviewers perform automated and complex reviews of claims including Part A B DMEPOS and Home Health Hospi ...