463 utilization review nurse jobs found

Description Become a key member of a world-class health organization. Contribute to the delivery of Magnet® designated nursing excellence. Take your career to the next level. Ucan do all this and more at UCLA Health. In this exciting and rewarding position, you will provide exceptional nursing care for our patients. You will offer guidance to team members by supervising nursing interventions and assigning related tasks. You will also assess patient, family and staff learning needs, deliver appropriate clinical education and promote effective working relationships. This involves collaborating with an interdisciplinary team of dedicated professionals to develop and implement a care plan, including providing detailed care instructions. The Utilization Review Nurse is part of the Utilization Management Department at the Resnick Neuropsychiatric Hospital, supporting inpatient, partial hospital, and intensive outpatient programs. Performs clinical reviews with third party payors...

Utilization Review Nurse I Division Emory Decatur Hospital Campus Location Decatur, GA, 30033 Campus Location US-GA-Decatur Department DEC-Care Management Job Type Regular Full-Time Job Number 106643 Job Category Nursing Schedule 8a-4:30p Standard Hours 40 Hours Description The shift for this position is 8a-4:30p   JOB DESCRIPTION: The Utilization Review Nurse (UR RN) is responsible for conducting medical necessity reviews by utilizing Millman and Interqual Guidelines in conjunction with a review of the patient chart, clinical nursing judgement, and discussions with the attending physician and/or physician advisor. The UR RN will perform utilization review by completing a timely and comprehensive review of all new observation and inpatient admissions for status designation as guided by criteria guidelines, patient presentation, and clinical nursing judgement. In addition, concurrent reviews will be completed as required by the payers, by accurately applying appropriate...

About CarolinaEast Medical Center CarolinaEast Health System is dedicated to quality and compassionate care across the Coastal Carolina region. The flagship of the health system is a 350 bed full service medical center housing a complete complement of inpatient and outpatient services with the latest technology. CarolinaEast Health System employs 2,500 dedicated team members. We have physician practices in various specialties spanning four counties. Our employees create a culture of excellence that connects our patients to the same level of care that is usually found at larger medical centers while maintaining a friendly, community feel throughout our facilities. CarolinaEast offers a comprehensive benefits package to all full time employees as well as benefits to part time plus and part time employees. Job Summary: Under the direction of the Utilization Review Manager and Physician Advisor, the Utilization Review Registered Nurse (UR-RN) assists in administration...

Job Description Overview Position: Case Manager Registered Nurse RN,Case Management Acute Care, PRN Per Diem, Variable Location: University Kansas Health System – St. Francis (Main Campus) Advancing Healthcare Together – The Future of Healthcare is in Topeka Kansas Why The University of Kansas Health System St. Francis Our People. Our people truly are our greatest strength. They make a massive difference in the amazing care we provide every day. We work closely together to create a positive experience for our patients and each other. Purpose. We will build on your experience and provide meaningful and purposeful career growth for your future. You will have the opportunity every day to make a difference in someone’s life and change the course of healthcare. Our Place. St. Francis Campus is proud to be a part of a long legacy of high-quality, compassionate care. For more than 100 years, the hospital has...

The position is primarily accountable for performing initial clinical appropriateness reviews of requests for services that require prior authorization, initial, concurrent and/or retrospective review The review process is performed in accordance with established patient (health plan) protocols/guidelines, benefits, and clinical appropriateness criteria (clinical screening criteria). This position works closely with the Care Coordinators, Discharge Planners, Social Workers, Registration and Providers to evaluate, monitor, and assure the appropriateness and medical necessity of selected care for patients as it relates to quality, continuity, and cost-effectiveness. This position works with clinical and non-clinical staff as part of the referral and/or authorization process. This position is responsible for managing utilization and, if necessary, discussing the utilization of service and standards of patient management. About Fairbanks Memorial Hospital...

Requisition Number 962 Remote? Yes   Why Work at AbsoluteCare? At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into  members : people who are entitled to some of the best, most focused care this country has to offer.  We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a...

Requisition Number 938 Remote? No  Monday through Friday, 8-5 with hour lunch, no weekends, no on-call, with paid holiday time off Why Work at AbsoluteCare? At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into  members : people who are entitled to some of the best, most focused care this country has to offer.  We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make...

Requisition Number 943 Remote? No  Monday through Friday, 8-5 with hour lunch, no weekends, no on-call, with paid holiday time off Why Work at AbsoluteCare? At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into  members : people who are entitled to some of the best, most focused care this country has to offer.  We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make...

Requisition Number 946 Remote? No  Monday through Friday, 8-5 with hour lunch, no weekends, no on-call, with paid holiday time off Why Work at AbsoluteCare? At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into  members : people who are entitled to some of the best, most focused care this country has to offer.  We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make...

Requisition Number 948 Remote? No  Monday through Friday, 8-5 with hour lunch, no weekends, no on-call, with paid holiday time off Why Work at AbsoluteCare? At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into  members : people who are entitled to some of the best, most focused care this country has to offer.  We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make...

Requisition Number 950 Remote? No  Monday through Friday, 8-5 with hour lunch, no weekends, no on-call, with paid holiday time off Why Work at AbsoluteCare? At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into  members : people who are entitled to some of the best, most focused care this country has to offer.  We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make...

Requisition Number952 Remote?No  Monday through Friday, 8-5 with hour lunch, no weekends, no on-call, with paid holiday time off Why Work at AbsoluteCare? At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into  members : people who are entitled to some of the best, most focused care this country has to offer.  We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make...

Requisition Number 876 Remote? Yes   Why Work at AbsoluteCare? At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into  members : people who are entitled to some of the best, most focused care this country has to offer.  We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a...

time type Full time posted on Posted 30+ Days Ago job requisition id R62663 Job Description: The RN Shared Leader supports the fundamentals of safety, quality, experience and stewardship by providing clinical expertise and leadership to their department. As a part of line management, this role will have significant leadership responsibilities, including several of the following: leading change, scheduling, maintenance of staff competencies, new employee selection / orientation, constructive discipline, and completion of annual employee performance reviews. The RN Shared Leader has accountability for coordination of a cohort of caregivers and actively participates in the overall operations of the department, development of department practice, and provision of patient care with specified accountabilities for implementation and outcomes. The RN Shared Leader supports and enforces department policies/procedures to ensure safe, efficient and effective patient care. Unit...

locations LDS Hospital time type Full time posted on Posted 30+ Days Ago job requisition id R56563 Job Description: The RN Coordinator II provides clinical expertise and leadership to their shift and/or department. Accountable for coordination of unit resources to ensure that staffing to census/acuity is clinically and financially appropriate. As a part of line management, this role has significant leadership responsibilities, including several of the following: scheduling, maintenance of staff competencies, new employee selection/orientation, constructive discipline, and completion of annual employee performance reviews. The RN Coordinator II supports and enforces unit policies and procedures to ensure safe, efficient and effective patient care. Job Essentials Assess: Performs appropriate assessment of physical, social and psychological status (including cognitive, communicative and developmental skills as appropriate). Seeks and evaluates information acquired from other...

locations Cassia Hospital time type Part time posted on Posted 30+ Days Ago job requisition id R56957 Job Description: The Nurse Case Manager utilizes clinical expertise and critical thinking skills to develop and implement a plan of care that provides cost effective, extraordinary care. This position works collaboratively with patients, patient families/significant others, healthcare providers, insurers, community resources, and other involved parties. Job Essentials Organizes and prioritizes daily work by assessing new, current, and discharging patient needs in area(s) of responsibility. Completes documentation as required. Performs utilization review activities to provide patient appropriate, timely, and cost effective care. Coordinates care with patient, care providers, hospital financial services, and third-party payers. Maintains an active role in denial prevention. Proactively intervenes with payers to prevent inpatient denials. Performs retroactive reviews on discharged...

remote type Hybrid Work locations Valley Center Tower time type Part time posted on Posted 5 Days Ago job requisition id R62513 Job Description: The Nurse Case Manager utilizes clinical expertise and critical thinking skills to develop and implement a plan of care that provides cost effective, extraordinary care. This position works collaboratively with patients, patient families/significant others, healthcare providers, insurers, community resources, and other involved parties. Job Essentials Organizes and prioritizes daily work by assessing new, current, and discharging patient needs in area(s) of responsibility. Completes documentation as required. Performs utilization review activities to provide patient appropriate, timely, and cost effective care. Coordinates care with patient, care providers, hospital financial services, and third-party payers. Maintains an active role in denial prevention. Proactively intervenes with payers to prevent inpatient denials. Performs...

locations LDS Hospital time type Full time posted on Posted Yesterday job requisition id R64719 Job Description: The RN Coordinator II provides clinical expertise and leadership to their shift and/or department. Accountable for coordination of unit resources to ensure that staffing to census/acuity is clinically and financially appropriate. As a part of line management, this role has significant leadership responsibilities, including several of the following: scheduling, maintenance of staff competencies, new employee selection/orientation, constructive discipline, and completion of annual employee performance reviews. The RN Coordinator II supports and enforces unit policies and procedures to ensure safe, efficient and effective patient care. Job Essentials Assess: Performs appropriate assessment of physical, social and psychological status (including cognitive, communicative and developmental skills as appropriate). Seeks and evaluates information acquired from other members...

ABOUT SHERIDAN MEMORIAL HOSPITAL Sheridan Memorial Hospital is a progressive, state-of-the-art facility nestled beneath the Big Horn Mountains in beautiful Northeast Wyoming. Founded over 100 years ago, Sheridan Memorial is licensed for 88 beds with over 60 physicians who provide primary medical care and specialty care in more than 15 areas. We are proud of our more than 700 employees who provide personalized, patient-centered care in a healing environment. When people think of excellent healthcare, they think of Sheridan. JOB SUMMARY Highly visible, hands-on position responsible for assisting clinicians with implementation of Electronic Health Records (EHR) systems, including advice and assistance associated with vendor product delivery as it pertains to hardware and software setup and system configuration for clinicians. Provides systems workflow advice during the implementation processes and provides re-design ideas, builds clinician workflows and...

Summary SIGN ON BONUS $10,000.00 Experienced RN We are hiring a Registered Nurse to work with our compassionate and dedicate Hospice team! Full Time; 8:00am to 4:30pm At Spartanburg Regional Outpatient Hospice, we are proud of our skilled, caring, trustworthy and compassionate Home Health experts. Our clinicians visit patient homes to deliver customized, physician-prescribed care. Nurses and medical professionals work closely with interdisciplinary teams to ensure patients are receiving optimum care tailored individual needs. Our Registered Nurses enjoy autonomy while caring for patients in their home environment. The team works with a wide variety of cases such as: Oncology, Alzheimer, Heart Failure, COPD, etc. The RN provides skilled nursing services within the home care setting in accordance with the orders of a physician and under a plan of care. Utilizes knowledge and skills at a competent level to provide...

This position provides comprehensive care coordination for patients as assigned. This position assesses the patient's plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating options and services to meet the patient's health care needs. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This position is accountable for the quality of clinical services delivered by both them and others and identifies/resolves barriers which may hinder effective patient care. About Fairbanks Memorial Hospital Fairbanks Memorial Hospital is a non-profit facility owned by the Greater Fairbanks Community Hospital Foundation. A Joint Commission-accredited facility with 152 licensed beds, Fairbanks Memorial Hospital is the primary referral center for residents of Alaska's interior with a strong patient-to-nurse ratio...

Assesses, plans, implements, evaluates, and documents nursing care of patients in a non-acute environment. Provides care in accordance with organizational policies, and in accordance with standards of professional nursing practice, utilizing the framework for professional nursing practice and development. Is accountable for the quality of nursing services delivered by self or others who are under his/her direction. Utilizes specialized knowledge, judgment, and nursing skills necessary to assess data, plan, provide, and evaluate care appropriate to the physical and developmental age of assigned patients. About Tanana Valley Clinic Tanana Valley Clinic (TVC) has provided state-of-the-art medical services to the Fairbanks Community and Interior Alaska for over 50 years. TVC is a 60-provider multi-specialty group. We have an excellent group of physicians and clinical staff, many of whom have been at TVC for 20+ years, as a testament to our friendly work...

The Denali Center is hiring for heart. We seek Licensed Practical Nurses (LPN) to provide nursing care in our loving, compassionate environment where both residents and staff and encouraged to learn and grow. Our award winning home-like environment promotes happiness by fostering relationships amongst residents, staff and volunteers. This position provides nursing care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the quality of nursing services delivered by self or others who are under his or her direction. This position observes, contributes to the plan of care, implements, reports and documents patient care in accordance with department policies, standard of care and state scope of practice. This position utilizes specialized knowledge, judgment, and nursing skills necessary to contribute to the assessment of data and to plan, provide and evaluate care appropriate to the physical and developmental...

Bilingual (Spanish Speaking) required.   This is a full-time position, 40 hours per week from 8:30am-5:00pm. This Nursing Care Manager with be working with unaccompanied minors who are enrolled in Therapeutic Foster Care.   The Nursing Care Manager I serves a designated population with specific commitments of assessment, planning for care throughout a continuum, monitoring services delivered, and evaluating collected data. The goal is to ensure the provision of high quality, outcome-oriented care to children and adolescents enrolled in Therapeutic Foster Care (TFC). Qualifications EDUCATION: Bachelor’s degree preferred. AA degree in nursing from an accredited school of nursing program with enrollment in a Bachelors degree and completion within two years of hire required. Active Nursing license from the Maryland Board of Nursing or compact state required. EXPERIENCE: Minimum two (2) years of related...