6 utilization review nurse rn jobs found

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...

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.

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.

Department: 37297 Carolinas Medical Center - LC: Infusion: Morehead Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: TBD Pay Range: $44.15 - $66.25 Essential Functions Develops a systematic education plan and...

Job Summary :  The Clinical Appeals Specialist is responsible for managing client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. Where warranted, the Clinical Appeals Nursing Specialist will write sound, compelling factual arguments in order to recoup revenue.    This position also facilitates collaboration between the Utilization Review Specialist's, Medical Staff, Physician Advisor, Nursing staff, Commercial Payers, VA, Managed Medicare Organizations, Medicare, and Medicaid (Center for Medicare/Medicaid Services) to ensure correct admission status as dictated by medical necessity criteria for correct reimbursement for level of care provided and to ensure that any denial is thoroughly reviewed and that an appeal letter, if warranted, is well written and submitted in a timely manner.   In addition, the following are essential duties and responsibilities of the Nurse Reviewer:...