230 utilization review nurse rn jobs found

LifeBridge Health, Inc. seeks a Utilization Review Nurse RN to evaluate medical necessity, level of care, and length of stay for hospitalized and ambulatory patients. The nurse reviews clinical documentation using InterQual/MCG and payer guidelines, collaborates with physicians and care teams, and communicates with insurers to obtain authorizations and prevent denials. Responsibilities include concurrent and retrospective review, documentation clarification, and escalation of complex cases. The role supports safe, cost-effective care, regulatory compliance, and optimal patient outcomes in a mission-driven, community-focused health system with strong opportunities for growth.

Summary: The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment. Interfaces with 3rd party payers by providing pertinent, relevant clinical information. Responsibilities Include: Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption. Enters clinical reviews into the software program. Maintains close communication with external reviewers/internal financial counselors/patient access personnel and performs certification activities as required by payor. Monitors and identifies patterns or trends in utilization management. Monitors potential and actual denials and coordinates with nurse Care Manager and/or Social Worker for any follow up necessary. Documents in software program the actions taken to coordinate care and avoid...

Work Schedule: This is an EVERY Saturday and Sunday role Summary: The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment. Interfaces with 3rd party payers by providing pertinent, relevant clinical information. Responsibilities Include: Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption. Enters clinical reviews into the software program. Maintains close communication with external reviewers/internal financial counselors/patient access personnel and performs certification activities as required by payor. Monitors and identifies patterns or trends in utilization management. Monitors potential and actual denials and coordinates with nurse Care Manager and/or Social Worker for any follow up necessary. Documents in...

Department: 35216 Atrium Health University City - Nursing Progressive Care Unit: Telemetry 6th Floor Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Monday through Friday variable with weekend/night visibility Pay...

Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials Compensation Disclaimer Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations. Department: OP Care Management Svcs FTE: 1.00 Full Time Shift: Days Position Summary: Responsible for the initial review, triage and assignment of patients to case managers and for the coordination of all systems and services required for an organized, multidisciplinary, patient centered care team approach. Assure quality, cost effective care for the identified patient population. Supervise staff in the department. Act as a resource and role model for staff. The incumbent also functions as a contact person for the patient, family, health care team members, community resources and employees. Ensure adherence to Hospitals and departmental policies and procedures. Patient care assignment may include...

RN CASE MANAGER - CARE MANAGEMENT DEPARTMENT - University of New Mexico Hospital - Albuquerque Inpatient Outpatient Utilization Management SRMC Care Management Full Time Part Time Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials Compensation Disclaimer Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations. Care Management Department Descriptions: Your application may be considered for any of the below programs. We will work with you to find the best fit. Inpatient Care Management: Supports patient's inpatient stay through care coordination, discharge planning and proactively discharging patient safely to the next level of care when medically ready. RN Case Managers have a 1:25-30 patient ratio and support all age groups from newborn to seniors. From birth to end of life needs. RN CM...

Trauma or ED experience preferred TNCC instructor preferred Position is not part of the UNMH Clinical Advancement Program Compensation Disclaimer Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations. Department: Clinical Education FTE: 1.00 Full Time Shift: Days Position Summary: Assess, plan, develop, implement and evaluate clinical and non-clinical educational programs for HSC Operational Components. Ensure adherence to Hospital and departmental policies and procedures. Patient care assignment may include neonate, pediatric, adolescent, adult and geriatric age groups. Detailed responsibilities: PATIENT SAFETY 1 - Follow patient safety-related policies, procedures and protocols PATIENT SAFETY 2 - Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes...

Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials Compensation Disclaimer Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations. Department: HIM Clinical Documentation FTE: 1.00 Full Time Shift: Days Position Summary: Responsible for concurrent review (during the patient stay) of appropriate and complete clinical documentation in the medical record to support services ordered and/or received, support primary diagnosis, secondary diagnoses, and co-morbidities to improve medical record physician documentation to appropriately support the severity of patient illness and resource consumption. Responsible for addressing and communicating appropriate documentation findings with physicians and other caregivers as necessary via written queries and/or verbal communication. Responsible for follow up to obtain accurate and complete...

Job Description Salary Range The expected base rate for this Glens Falls, New York, United States-based position is $40.83 to $60.74 per hour. (Exact rate is determined on a case-by-case basis commensurate with experience level, as well as education and certifications pertaining to each position which may be above the listed job requirements.) The Impact You Can Make The Case Manager (Acute Care) role must optimize and integrate the interface between clinical and financial systems supporting positive health outcomes. The Case Manager uses nursing and case management knowledge to promote appropriate allocation of hospital and other resources, while striving to provide high quality care to each patient in a cost effective and timely manner. Support services provided by the Case Manager include, but are not limited to, utilization review, case management, weekend and holiday case management, care transition, collaboration with physicians and social workers for care...

POSITION SUMMARY/RESPONSIBILITIES Provides support for the Health System's quality improvement functions through the analysis of data and indicators. Responsible for identifying and monitoring ongoing quality improvement issues and opportunities. Assists in the development of process metrics, data collection tools and presentations of resultant data throughout the Health System. Serve as facilitator/leader of process improvement efforts. Engages with Senior Leadership, Department Directors, Educators, and their staff and physician/provider leaders/representatives. Work collaboratively with all members of the healthcare team. Reviews patient information, screening the information through the appropriate review process for accurate and complete documentation of a patient's care to meet quality guidelines and regulations. EDUCATION/EXPERIENCE Bachelor's degree in nursing required. Three or more years of relevant clinical experience are required. Experience with...

POSITION SUMMARY/RESPONSIBILITIES Provides support for the Health System's quality improvement functions through the analysis of data and indicators. Responsible for identifying and monitoring ongoing quality improvement issues and opportunities. Assists in the development of process metrics, data collection tools and presentations of resultant data throughout the Health System. Serve as facilitator/leader of process improvement efforts. Engages with Senior Leadership, Department Directors, Educators, and their staff and physician/provider leaders/representatives. Work collaboratively with all members of the healthcare team. Reviews patient information, screening the information through the appropriate review process for accurate and complete documentation of a patient's care to meet quality guidelines and regulations. EDUCATION/EXPERIENCE Bachelor's degree in nursing required. Three or more years of relevant clinical experience are required. Experience with...

POSITION SUMMARY/RESPONSIBILITIES Provides support for the Health System's quality improvement functions through the analysis of data and indicators. Responsible for identifying and monitoring ongoing quality improvement issues and opportunities. Assists in the development of process metrics, data collection tools and presentations of resultant data throughout the Health System. Serve as facilitator/leader of process improvement efforts. Engages with Senior Leadership, Department Directors, Educators, and their staff and physician/provider leaders/representatives. Work collaboratively with all members of the healthcare team. Reviews patient information, screening the information through the appropriate review process for accurate and complete documentation of a patient's care to meet quality guidelines and regulations. EDUCATION/EXPERIENCE Bachelor's degree in nursing required. Three or more years of relevant clinical experience are required. Experience with...

POSITION SUMMARY/RESPONSIBILITIES Provides support for the Health System's quality improvement functions through the analysis of data and indicators. Responsible for identifying and monitoring ongoing quality improvement issues and opportunities. Assists in the development of process metrics, data collection tools and presentations of resultant data throughout the Health System. Serve as facilitator/leader of process improvement efforts. Engages with Senior Leadership, Department Directors, Educators, and their staff and physician/provider leaders/representatives. Work collaboratively with all members of the healthcare team. Reviews patient information, screening the information through the appropriate review process for accurate and complete documentation of a patient's care to meet quality guidelines and regulations. EDUCATION/EXPERIENCE Bachelor's degree in nursing required. Three or more years of relevant clinical experience are required. Experience with...

POSITION SUMMARY/RESPONSIBILITIES Provides support for the Health System's quality improvement functions through the analysis of data and indicators. Responsible for identifying and monitoring ongoing quality improvement issues and opportunities. Assists in the development of process metrics, data collection tools and presentations of resultant data throughout the Health System. Serve as facilitator/leader of process improvement efforts. Engages with Senior Leadership, Department Directors, Educators, and their staff and physician/provider leaders/representatives. Work collaboratively with all members of the healthcare team. Reviews patient information, screening the information through the appropriate review process for accurate and complete documentation of a patient's care to meet quality guidelines and regulations. EDUCATION/EXPERIENCE Bachelor's degree in nursing required. Three or more years of relevant clinical experience are required. Experience with...

Mission Health in Asheville, NC seeks a Care Manager Registered Nurse to coordinate patient care across the continuum. The RN Care Manager conducts assessments, develops individualized care plans, facilitates transitions of care, and collaborates with physicians, social workers, and community resources to optimize outcomes. Responsibilities include utilization review, discharge planning, patient and family education, and advocacy. This role requires strong clinical judgment, documentation skills, and the ability to work in a fast-paced hospital environment focused on quality, safety, and patient-centered care.

Mission Health in Asheville, NC seeks a Care Manager Registered Nurse to coordinate patient care across the continuum. The RN Care Manager conducts assessments, develops individualized care plans, facilitates transitions of care, and collaborates with physicians, social workers, and community resources to optimize outcomes. Responsibilities include utilization review, discharge planning, patient and family education, and advocacy. This role requires strong clinical judgment, documentation skills, and the ability to work in a fast-paced hospital environment focused on quality, safety, and patient-centered care.

Job Description: The RN Hospital Care Manager I delivers comprehensive care management services to designated patients, leveraging clinical expertise for screenings, assessments, and evaluations. This role involves developing and implementing patient-centered care plans with shared goals and tailored interventions. The Care Manager collaborates seamlessly with patients, families/caregivers, healthcare providers, payers, community-based providers, and other stakeholders to ensure efficient, effective, and patient-focused care management. This position spans various departments, including both Inpatient and Outpatient areas. Shift Details: Saturday + Sunday - Essential Functions Assessment: Identifies patients using screening criteria and conduct comprehensive evaluations. Care Planning: Develops, adjusts, and coordinates care plans to address medical and social needs. Patient Support: Guides self-management using motivational interviewing and coaching. Education &...

Description Our Registered Nurse Case Managers (RNCM) have been called to care when they're needed most. At Interim HealthCare, you'll support a full range of patient services to bring comfort and dignity to our clients. Territory covered: Morgan county What we offer our Registered Nurse Case Managers (RNCM): Competitive pay, benefits, and incentives. Truly flexible scheduling - a dedication to work/life balance - Full-time Daily Pay option available No Overtime Required 1:1 patient care Working at Interim HealthCare means a career unlike any other. With integrity at the center of all we do, we know that when we support you and your community, you'll change lives every day. As a Registered Nurse Case Manager (RNCM), you will: Conduct In Person patient interviews and comprehensive physical assessments. Oversee the implementation and ongoing assessment of the patient's plan of care through the management of home health aides, LPNs, RNs, and other caregivers....

Description Our Registered Nurse Case Managers (RNCM) have been called to care when they're needed most. At Interim HealthCare, you'll support a full range of patient services to bring comfort and dignity to our clients. Territory covered: Morgan county What we offer our Registered Nurse Case Managers (RNCM): Competitive pay, benefits, and incentives. Truly flexible scheduling - a dedication to work/life balance - Full-time Daily Pay option available No Overtime Required 1:1 patient care Working at Interim HealthCare means a career unlike any other. With integrity at the center of all we do, we know that when we support you and your community, you'll change lives every day. As a Registered Nurse Case Manager (RNCM), you will: Conduct In Person patient interviews and comprehensive physical assessments. Oversee the implementation and ongoing assessment of the patient's plan of care through the management of home health aides, LPNs, RNs, and other caregivers....

Description Our Registered Nurse Case Managers (RNCM) have been called to care when they're needed most. At Interim HealthCare, you'll support a full range of patient services to bring comfort and dignity to our clients. This position will cover our Saint Clairsville, OH region. What we offer our Registered Nurse Case Managers (RNCM): Competitive pay, benefits, and incentives. Truly flexible scheduling - a dedication to work/life balance - Full-time Daily Pay option available No Overtime Required 1:1 patient care Working at Interim HealthCare means a career unlike any other. With integrity at the center of all we do, we know that when we support you and your community, you'll change lives every day. As a Registered Nurse Case Manager (RNCM), you will: Conduct In Person patient interviews and comprehensive physical assessments. Oversee the implementation and ongoing assessment of the patient's plan of care through the management of home health aides, LPNs,...