Utilization Review Nurse Jobs in the United States
Providence Health and Services
$52.26 - $81.13
Seattle, WA
It is comprised of eight hospital campuses (Ballard, Edmonds, Everett, Centralia, Cherry Hill (Seattle), First Hill (Seattle), Issaquah and Olympia); emergency rooms and specialty centers in Redmond (East King County) and the Mill Creek area in Everett; and Providence Swedish Medical Group, a network of 190+ primary care and specialty care locations throughout the Puget Sound. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Williamson Health
Murfreesboro, TN
The flagship facility, Williamson Medical Center, which recently opened its new Boyer-Bryan West Tower, offers extensive women's services, state-of-the-art cardiology services, advanced surgical technologies, an award-winning obstetrics and NICU, leading-edge orthopaedics, outpatient imaging services, and distinct comprehensive emergency and inpatient services for both adult and pediatric patients. Timely reviews patients within 24 hours or next business day after admission and at a minimum of every 2 days thereafter for continued stay, applying appropriate criteria (Interqual®) and facilitating reimbursement for services with third payer parties, obtaining and entering authorization number/approval status and notes in Meditech.
Providence Health and Services
$46.3 - $91.32
Olympia, WA
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate admission status based on regulatory and reimbursement requirements of commercial and government payers.
Epitec, Inc
Albuquerque, NM
Knowledge, Skills, Abilities Required: • Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member. Essential Duties and Responsibilities: • Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies and compliance guidelines.
Nationwide Therapy Group
$1917
Torrance, CA
This includes offering exceptional pay packages along with these great benefits: Medical, dental, and vision insurance. NTG is committed to matching you to the right position and we pride ourselves on our commitment to our travelers.
Liberty Health
Greenville, NC
Must have a current, unrestricted Registered Nurse license in the state of assignment or the ability to obtain and submit proof of license renewal every other year. Completes assessment on members within 72 hours of discharge from ED, Hospital, SNF, or Home Health episode to ensure stability and continuity of care.
Providence Health and Services
$44.16 - $77.58
Jber, AK
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The goal of the Inpatient Care Management RN is to ensure the use of appropriate healthcare resources throughout the continuum, so that the care provided is the right care, at the right time, in the right setting.
Alderwood Manor
$52 - $58
Spokane, WA
Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Providence Health and Services
$44.16 - $77.58
Big Lake, AK
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The goal of the Inpatient Care Management RN is to ensure the use of appropriate healthcare resources throughout the continuum, so that the care provided is the right care, at the right time, in the right setting.
Providence Health and Services
$43.29 - $76.06
Anchorage, AK
Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, outreach programs, and hospice and home care. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Providence Health and Services
$44.16 - $77.58
Wasilla, AK
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The goal of the Inpatient Care Management RN is to ensure the use of appropriate healthcare resources throughout the continuum, so that the care provided is the right care, at the right time, in the right setting.
Life Care Center of Post Falls
$44.5 - $51.64
Post Falls, ID
Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Providence Health and Services
$44.16 - $77.58
Jber, AK
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The goal of the Inpatient Care Management RN is to ensure the use of appropriate healthcare resources throughout the continuum, so that the care provided is the right care, at the right time, in the right setting.
ChristianaCare
$41.28 - $66.05
Wilmington, DE
ChristianaCare includes an extensive network of primary care and outpatient services, home health care, urgent care centers, three hospitals (1,336 beds), a freestanding emergency department, a Level I trauma center, and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care and women’s health. Incredible Work/Life benefits including annual membership to care.com, access to backup care services for dependents through Care@Work, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets and much more!
Luminis Health
$40 - $60
Lanham, MD
Coordinate patients, equipment and staffing through effective planning and communication with the Charge Nurse and CSP for efficient case flow meeting targeted unit metrics. Contributes to the provision of high quality, cost-effective patient care and collaboration with other health care team members, with emphasis on designated service lines.
Renaissance Park Multi Care Center
Benbrook, TX
Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Life Care Center of Lewiston
$37 - $40
Lewiston, ID
Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Greenlife Healthcare Staffing
Jericho, NY
Greenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a Non-profit organization located in New York. Soft Skills: Excellent written/verbal communication; ability to work independently; flexible and innovative; meets deadlines in sensitive environments; strong collaborative and problem-solving skills.
Luminis Health
$34 - $55
ANNAPOLIS, MD
Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilizes Physician Advisor and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor to resolve payer issues. 2. Denial Management: Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken to avoid denial; assists Care Coordinator in communicating with the patient denied hospital days with work toward resolution and discharge.
Jobot
$78000 - $90000
Lawrence, MA
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Contact: https://jobot.com/apply/rn-case-manager-hybrid-mon-fri-days/1184484381?utm_source=Monster
Life Care Center of Longmont
$35 - $46.08
Longmont, CO
Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Kaiser Permanente
Denver, CO
EducationGraduate of board approved RN program and completed a minimum of 750 clock hours of faculty planned clinical experience and guided learning activities which required direct supervision by faculty, associate nursing instructional personnel (ANIP) or preceptor who is physically present or immediately accessible. Such functions include the initiation and performance of nursing care through health promotion, supportive or restorative care, disease prevention, diagnosis and treatment of human disease, ailment, pain, injury, deformity, and physical or mental condition using specialized knowledge, judgment, and skill involving the application of biological, physical, social, and behavioral science principles.
Kaiser Permanente
Denver, CO
Graduate of board approved RN program and completed a minimum of 750 clock hours of faculty planned clinical experience and guided learning activities which required direct supervision by faculty, associate nursing instructional personnel (ANIP) or preceptor who is physically present or immediately accessible. Such functions include the initiation and performance of nursing care through health promotion, supportive or restorative care, disease prevention, diagnosis and treatment of human disease, ailment, pain, injury, deformity, and physical or mental condition using specialized knowledge, judgment, and skill involving the application of biological, physical, social, and behavioral science principles.
Providence Health and Services
$46.3 - $91.32
Lacey, WA
Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care.
Providence Health and Services
$47.73 - $89.59
Everett, WA
Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care.
Providence Health and Services
$46.3 - $91.32
Dupont, WA
Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care.
Providence Health and Services
$47.73 - $89.59
Everett, WA
Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care.
Kaiser Permanente
Portland, OR
Provide care coordination and management services for members with identified needs: Creatively using available and appropriate resources, including KP staff and providers, to support the unique needs of each member; Facilitating access to internal and external services; Monitoring the effectiveness of the interventions; and reinforces the treatment plan. The RN Case Manager provides a variety of nursing services both in person, by phone and via electronic media utilizing nursing process and leadership skills to address acute and chronic needs of Health Plan members and other patients of the Kaiser Permanente Health Care Program.
Wooldridge Place Nursing Center
Corpus Christi, TX
Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Liberty Health
Candler, NC
Collaborates with the broad range of Plan and Facility Interdisciplinary Care Team members (including Plan Medical Director, Nurses, and Utilization Management staff; Interdisciplinary Facility Leadership, Medical Director, Attending Physicians, Advanced Practice Providers, Nurses, aides, and other staff; and others). Maintain effective communication with Liberty Advantage Administrative Director, Medical Director, and/or Lead Nurse Practitioner or other assigned Provider, to ensure effective implementation of Liberty Advantage Model of Care.
Belen Meadows HC and Rehab Ctr
$40
Belen, NM
Facilitate a person-centered team approach to skin and wound prevention and management, working alongside nursing center leadership, nursing staff, physicians, therapists, dietitians, and families. As our Skin Health Team Lead, you will be a champion for skin integrity, working closely with our interdisciplinary team, patients, and their families to prevent and effectively manage skin and wound concerns.
Providence Health and Services
$47.73 - $89.59
Lynnwood, WA
Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care.
Envision Unlimited
Tinley Park, IL
Summary: The Medical Care Manager (MCM) is a member of the interdisciplinary team providing pre- and post-transition medical care management and clinical services to persons with mental or physical illness who are part of the Williams or Colbert Class Membership. Innovative services offered across Chicagoland and Central Illinois include community living options, novel day programs, behavioral health services, employment programs, respite for families, and foster care for children with disabilities.
TalentBurst, Inc.
$35 - $36.5
Bluefield, VA
Location: Bluefield, VA Summary: Under the direction of the RN Nursing Supervisor, Unit Manager, ADON or ADON Unit, or Center Nurse Executive (Nurse Leader), the Registered Nurse (RN) delivers efficient and effective nursing care while achieving positive clinical outcomes and patient/family satisfaction. He/she operates within the scope of practice defined by the State Nurse Practice Act and delegates aspects of patient care to LPNs and CNAs consistent with their scope of practice.
BoldAge PACE
$42 - $48
Fresno, CA
Provide coordination and direct care as indicated to promote continued care in the community or promote optimal institutional care (Assisted Living, Nursing Home, Hospital, etc.) as needed. Teach participants, caregivers and families about self-care, medications, healthy lifestyles, infection control and safety to promote optimal health and safety.
Aveanna Healthcare
$60000 - $72000
Birmingham, AL
See Aveanna Healthcare Terms & Conditions at https://www.aveanna.com/privacypolicy.html and Privacy Policy at https://www.aveanna.com/privacypolicy.html and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions. The Hospice Registered Nurse is responsible for pain management, symptom control in the delivery of care to hospice patients, as established by the plan of care, the interdisciplinary team, attending physician and Hospice Medical Director.
Professional Case Management
$44 - $46
Prosser, WA
Our Senior RN-Case Managers Direct assigned team members of RN Case Managers in the provision of care in accordance with Agency policy and with state-specific nurse practice act, and regulatory requirements. Please contact Rick Carey at (866) 776-0127 x350 or at rick.carey@procasemanagement.com today to learn more about our opportunities where you can make a difference in your own career!
Jobot
$105000 - $115000
Queens, NY
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. The Nurse Care Manager will work with the member and/or family member to maintain the most independent living situation possible; ensure consistent care along the entire health care continuum by assessing and closely monitoring member’s needs and status.
Deborah Heart and Lung Center
BROWNS MILLS, NJ
Responsible for insuring and facilitation the achievement of quality, clinical, and cost outcomes, seeking approval for and arranging services and resources needed by the patient and family, intervening at key points for individual patients to meet defined patient outcomes. When determining a team members base rate, several factors may be considered as applicable (e.g., years of recent relevant experience, education, credentials, and internal equity).
Jobot
$115000 - $120000
New York, NY
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Reporting to the Supervisor of Care Management this position will provide case management to our members including medical, social, psychological, physical, and spiritual needs by developing, implementing, and monitoring the care plan in.