261 utilization review rn jobs found

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession:  Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas:  Continuously innovate by embracing emerging technology and fostering a culture of creativity and...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession:  Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas:  Continuously innovate by embracing emerging technology and fostering a culture of creativity and...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession:  Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas:  Continuously innovate by embracing emerging technology and fostering a culture of creativity 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:...

Overview Utilization management is the analysis of the medical necessity, acute care appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for admission to the hospital as well as continued stay. This function ensures that services are not only appropriate, but ensures that an authorization for services is obtained from payer, if required, and that documentation supports the care delivered in such a way that minimizes the risk of denials after discharge. Qualifications Required Education: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse Preferred Education: Bachelors Science Nursing or higher Required Experience: 2 years previous nursing experience Preferred Experience: Utilization Review or Case Management experience Required License/Registration/Certification:...

Hello, Thank you for your interest in career opportunities with the University of Mississippi Medical Center.  Please review the following instructions prior to submitting your job application: Provide all of your employment history, education, and licenses/certifications/registrations.  You will be unable to modify your application after you have submitted it. You must meet all of the job requirements at the time of submitting the application.  You can only apply one time to a job requisition.  Once you start the application process you cannot save your work. Please ensure you have all required attachment(s) available to complete your application before you begin the process. Applications must be submitted prior to the close of the recruitment. Once recruitment has closed, applications will no longer be accepted. After you apply, we will review your qualifications and contact you if your application is among the most highly qualified. Due to the...

Hello, Thank you for your interest in career opportunities with the University of Mississippi Medical Center.  Please review the following instructions prior to submitting your job application: Provide all of your employment history, education, and licenses/certifications/registrations.  You will be unable to modify your application after you have submitted it. You must meet all of the job requirements at the time of submitting the application.  You can only apply one time to a job requisition.  Once you start the application process you cannot save your work. Please ensure you have all required attachment(s) available to complete your application before you begin the process. Applications must be submitted prior to the close of the recruitment. Once recruitment has closed, applications will no longer be accepted. After you apply, we will review your qualifications and contact you if your application is among the most highly qualified. Due to the...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. Partners with the health care team to ensure reimbursement of hospital admissions is based on medical necessity and documentation is sufficient to support the level of care being billed. Conducts concurrent reviews as directed in the hospital’s Utilization Review Plan and review of medical records to ensure criteria for admission and continued stay are met and documented. Along with other health care team members, monitors the use of hospital resources and identifies delays. Job Description: Essential Functions and Responsibilities: 1, Performs a variety of concurrent and retrospective utilization...

Registered nurses in the Neuroscience Intensive Care Unit at UK Chandler Hospital provide intensive neurological and neurosurgical care for adult patients ranging from 15 years of age and older. Patient conditions include isolated head trauma, ischemic or hemorrhagic stroke, spinal cord injury, anoxic brain injuries and other diseases of the brain and spinal cord. The RN serves as an important component of the critical care team; responsible for close hemodynamic, medication and ventilator monitoring and treatment of patient complications related to their neurological injury. The primary responsibilities for this position consist of providing total, comprehensive, continuous and patient centered care which includes: assessing, documenting, planning, implementing, teaching, developing, and evaluating a comprehensive nursing plan of care; delivering direct patient care; ensuring patient satisfaction; training and delegating duties for Nursing Care Technicians (Nursing Assistant);...

Nurse Manager – PCU     Are you looking for a rewarding career with top-notch benefits? We are looking for a qualified Manager   like you to join our Texas Health family.   Position Highlights Work location:  Texas Health Southwest Core Work hours: Monday – Friday; 8:00a-5:00p   At Texas Health Southwest and Texas Health Clearfork, we operate as one hospital across two locations, proudly serving Fort Worth, Benbrook, Crowley, Aledo, Granbury, and the surrounding southwest Fort Worth communities since 1987. Our 261-bed, full-service hospital provides convenient access to care for patients across Tarrant County.  Our specialties include surgical services, orthopedics, imaging, and adult critical care. We also offer a 24-hour emergency department and are certified as a Primary Heart Attack Center, Primary Stroke Center, Level III Trauma Center, Level III Maternal Center, Level III Neonatal Center, and a nationally accredited facility for...

Nurse Manager – Med/Surg    Are you looking for a rewarding career with top-notch benefits? We are looking for a qualified Leader   like you to join our Texas Health family.   Position Highlights Work location:  Texas Health Plano Core Work hours: Monday – Friday; 8:00a-5:00p;   Since 1991, Texas Health Presbyterian Hospital Plano has served the communities of Plano, Frisco, Carrollton, Addison, Richardson, and McKinney. As a 386-bed, full-service hospital, we're proud to deliver exceptional care to North Texans through advanced technology and a dedicated team.   We offer a range of specialties, including emergency medicine and trauma, cardiology, neurosurgery and spine care, orthopedics, women's services, adult and adolescent behavioral health, and critical care. Our hospital also provides comprehensive surgical services supported by leading technology and clinical expertise.   As we look to the future, a new patient tower under...

Department: 34909 Advocate Illinois Masonic Medical Center - Behavioral Health: IU 631 Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: M-F 8 am- 4:30 pm Pay Range: $35.50 - $76.60 Major Responsibilities:...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Under the general supervision of the ACNO of Inpatient Services & Staffing Office, The Patient Flow, Admissions & Discharge Registered Nurse (RN) is responsible for assessments and tasks associated with smooth patient care movement. The main function includes coordinating and completing patient admissions and discharges on designated patient care units as determined by the needs of the hospital. This role ensures a safe, efficient, and patient-centered transition into the inpatient setting by conducting comprehensive admission assessments, medication reconciliation, patient and family education, and other tasks related to supporting the patient and hospital unit workload. This role helps decrease the workload on bedside nurses, allowing them to focus more on direct patient care while supporting operational efficiency and patient flow. This aligns with the...

$2,000 Sign On Bonus!  Full time position is Tuesday-Saturday and nurse on call rotation required, Come grow with us! Life Care Center of Longmont is proud to have achieved the following accolades: US News & World Report's Best Nursing Homes for 2026 for high-performing long-term care and short-term rehab "800 Club" membership in 2025, an elite designation of the highest performing businesses on Reputation.com. 5-Star CMS Rating for Quality Measures 4.8 Google star rating out of 666 Google reviews Position Summary The RN Care Manager is responsible for the coordination of the patient’s care and services. Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Works together with the patient and family, care team, payers, and external entities to promote a safe transition from...

    Position Summary   The Clinical Reviewer Specialist is responsible for performing clinical and medical necessity reviews to support the timely and accurate processing of member and provider appeals. This role evaluates medical records, clinical documentation, and applicable criteria to determine medical necessity and prepare recommendations for Medical Director review. The Clinical Reviewer Specialist ensures compliance with organizational policies, State and Federal regulations, Medicaid requirements, and NCQA standards while delivering high-quality appeal determinations and communications.   This position is eligible for company benefits including medical, dental, and vision insurance with an employer contribution, flexible spending or health savings account, life and AD&D insurance, short- and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required...

About this Job: Please Note: This position is an Evening/ Night shift   General Summary of Position The Assistant Director of Nursing is a member of MedStar Health entity-based Division of Nursing and leadership team. Supports and collaborates with the Director of Nursing in providing leadership and oversight for a specific unit/department. Directs and coordinates the nursing and patient care delivery of the unit-based professional and support personnel. Ensures the provision of holistic culturally competent and person-centered quality safe and cost-effective evidence-based nursing care for patients/families. Applies the nursing process within the context of the organization's shared/collaborative decision-making framework. Collaboratively manages the patient's transitions across the continuum of care to assist patients and populations in achieving or maintaining an optimal level of health and functioning.The Assistant Director of Nursing assumes administrative and leadership...

JOB REQUIREMENTS Education  Required Current Arkansas State RN license. Experience RN with previous case management experience preferred, but not necessary. Effective communication – both written and verbal. Excellent interpersonal skills, ability to establish rapport. Knowledge of clinic policies/procedures, practices, techniques, and equipment as acquired through orientation. Keyboarding skills required. Windows skills preferred. Physical This is a safety sensitive position. Please see the St. Bernards Substance Abuse Policy for further information. Normal clinic environment. Exposure to biological hazards. Frequent exposure to unpleasant odors. Close eye work. Hearing of normal and soft tones. Distinguish smells. Distinguish temperatures by touch and proximity. Lifting up to 100 lbs. carrying up to 40 lbs. Pushing/pulling up to 350 lbs. Frequent sitting, standing, walking, bending, stooping,...

JOB REQUIREMENTS Education  Required Current Arkansas State RN license. Experience RN with previous case management experience preferred, but not necessary. Effective communication – both written and verbal. Excellent interpersonal skills, ability to establish rapport. Knowledge of clinic policies/procedures, practices, techniques, and equipment as acquired through orientation. Keyboarding skills required. Windows skills preferred. Physical This is a safety sensitive position. Please see the St. Bernards Substance Abuse Policy for further information. Normal clinic environment. Exposure to biological hazards. Frequent exposure to unpleasant odors. Close eye work. Hearing of normal and soft tones. Distinguish smells. Distinguish temperatures by touch and proximity. Lifting up to 100 lbs. carrying up to 40 lbs. Pushing/pulling up to 350 lbs. Frequent sitting, standing, walking, bending, stooping,...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession:  Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas:  Continuously innovate by embracing emerging technology and fostering a culture of creativity and...

Department: 34033 Wake Forest Baptist Medical Center - Nursing: Care Coordination Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Typical schedule Mon-Friday 8-5pm. May volunteer an occasional weekend shift to cover...