- AmeriHealth Caritas (Newtown Square, PA)
- …Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred. + An active Registered Nurse ( RN ) license in good standing or compact state ... to document and assess patient cases efficiently. + Strong understanding of utilization review processes, including medical necessity criteria (eg Interqual),… more
- Monroe Plan for Medical Care (Albany, NY)
- Utilization Reviewer RN Summary Title: Utilization Reviewer RN ID:UM41-ALBANY Location:Albany Job Type:Full-time Date Posted:04/17/2025 Openings:1 ... HAS DIRECT REPORTS:NoESSENTIAL JOB DUTIES/FUNCTIONS % of Time Essential Function 75 Utilization Review Functions Perform utilization review … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
- The Cigna Group (Bloomfield, CT)
- …Other duties as required and related to this role. **Minimum requirements:** + Active unrestricted Registered Nurse ( RN ) license in state or territory of the ... knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management. RN and current unrestricted nursing license required.… more
- AmeriHealth Caritas (Charleston, SC)
- …licensure/independent licensure required: LPC, LCSW, LISW, LICSW, LCMHC, LMHC, LMFT or RN ( Registered Nurse graduated from an accredited institution ... Under the direction of the Supervisor, the Behavioral Health Utilization Management Reviewer is responsible for completing...all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer… more
- Penn State Health (Lancaster, PA)
- …family medical or genetic information._ **Position** RN Registered Nurse - VARIED SHIFT - Corporate Services Utilization **Location** US:PA:Lancaster | ... **MINIMUM QUALIFICATION(S):** + Currently licensed to practice as a Registered Nurse by state of employment or... by state of employment or holds a multistate RN license through the interstate Nurse Licensure… more
- US Tech Solutions (Canton, MA)
- …required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is expected to function independently in her / ... complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical...the job** + Bachelor's degree in Nursing, preferred + Registered Nurse with current a and unrestricted… more
- Crouse Hospital (Syracuse, NY)
- …outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse ( RN ) to track and manage data and client ... requires 6 weekends a year). Utilization Management Registered Nurse ( RN ) Position Responsibilities:...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …insurance products and benefits, as well as regulatory and NCQA requirements. + Refer to RN or PT Clinical Utilization reviewer for more complex cases as ... Conduct pre-certification, concurrent, and retrospective reviews with emphasis on utilization management, discharge planning, care coordination, clinical outcomes, and… more
- Ascension Health (Baltimore, MD)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more