260 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...

  Nurse Manager II-Operating Room   Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We’re looking for qualified candidates like you to join our Texas Health family.   Texas Health Denton Since 1987, Texas Health Denton has served the Denton community and surrounding areas including Corinth, Lake Dallas, Argyle, Sanger, Aubrey, and communities throughout North Texas and southern Oklahoma. As a 255-bed, full-service hospital with more than 1,100 employees and 486 physicians on our medical staff, we're one of the largest employers in Denton County.  We offer advanced care in robotic and endovascular surgery, general surgery, orthopedics and sports medicine, spine and back services, emergency medicine, and bariatric surgery. Additional services include cancer treatment, critical care, neonatology, cardiac CT imaging, neurology, electrophysiology, stroke care, vascular care, women's and infants' services,...

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...

Department: 34039 Enterprise Corporate - Administration: Resource Team Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Experience: Seeking a candidate with a minimum of 5 years of RN experience , including at least 1...

About this Job: Director of Nursing, Psychiatry (Nurse Manager) Job Overview   The Nurse Manager (Director of Nursing) is a member of MedStar Health entity-based Division of Nursing's (DON) leadership/management team and is responsible for the adult inpatient psychiatric unit, child and adolescent psychiatric unit and psychiatric ED unit of organized nursing and patient care services.     Adult Inpatient Unit Highlights 29-bed acute adult inpatient psychiatry  Evidenced-based mental health treatment Hospital-based Protection Services (Security) Department Experienced leadership Opportunity to be engaged with change management High Reliability Organization with a Just Culture/Culture of Safety Supportive environment     Psych Crisis Stabilization Unit Highlights   10-bed busy specialized psychiatric emergency unit, located within the main medical ED   Treats pediatric and adult patients   Security has a strong partnership and...

About this Job: 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 authority and responsibility on a 24 hours/7 days per week...

About this Job: Director of Nursing, Intensive Care Unit (Nurse Manager) Job Overview   The Nurse Manager (Director of Nursing) is a member of MedStar Health entity-based Division of Nursing's (DON) leadership/management team and is responsible for the comprehensive medical ICU, neurological ICU and patient care services.     Intensive Care Unit Highlights 42-bed unit including 15 beds dedicated to Neurological Critical Care Patients Servicing a wide patient population set included but not limited to medical, respiratory, cardiac, renal failure, GI and surgical patients     General Summary of Position The Director of Nursing is a member of MedStar Health entity-based Division of Nursing's (DON) leadership/management team and is responsible for one or more defined units/departments of organized nursing and patient care services. Creates a practice environment that exemplifies the values of patient care and implements a patient and nursing care delivery system...

About this Job: General Summary of Position The Nursing Professional Development (NPD) Specialist functions within the roles of educator change agent consultant evidence-based practitioner and leader. The NPD Specialist is responsible for assessment planning development implementation and evaluation of learning and development programs that enhance associates' performance promote professional development or otherwise support the mission vision and SPIRIT Values of MedStar Health and the Department of Nursing.  Experience in Electrophysiology and Cardiac Cath Lab is required.   Primary Duties and Responsi bilities   LEARNING AND EDUCATION1.Demonstrates clinical expertise leadership communication skills and knowledge of education theory and principles necessary to develop learning programs and achieve optimal educational outcomes. 2.Designs implements and evaluates designated learning and educational programs and consultative services. Assesses learning needs through...

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...