Top 37959 Rn And Lpn's Jobs

Utilization Specialist
RiverWoods Behavioral Health —Riverdale, GA
- Part-time
- CPR Certification
- Nursing
- RN License
RN/LPN for Corporate Vaccinations and Health Screenings PRN
TotalWellness —Durango, CO
- $32 - $42 an hour
- Online Application
- RN License
- Computer literacy
- Computer skills
- Flexible schedule
Quick Apply
4d
Call Center: Telecare Registered Nurse (RN) -Local Remote Role
VITAS Healthcare —Phoenix, AZ
- $36 - $41 an hour
- Full-time
- Remote
- Nursing
- Anatomy knowledge
- RN License
- Disability insurance
- Health insurance
Quick Apply
LPN and RN ** Immediate work available
NurseStat —Santa Fe, NM
- $32 - $70 an hour
- Temporary
- CPR Certification
- RN License
- BLS Certification
- Paid holidays
Quick Apply
Utilization Review Nurse (RN)
Lighthouse Care Center of Augusta —Augusta, GA
- Full-time
- Nursing
- Psychiatry
- RN License
- Health insurance
- Dental insurance
Quick Apply
Behavioral Health Care Manager (LPN/RN)
Lumina Care —Remote
- $27 - $35 an hour
- Full-time
- Remote
- Nursing
- Psychiatry
- RN License
- Paid holidays
- Health insurance
Quick Apply
Licensed Appeal Writer - Remote
Med-Metrix —Remote
- $75,000 - $85,000 a year
- Full-time
- Remote
- RN License
- Customer service
- Physical & Rehabilitation Medicine
Patient Care Coordinator
Gracey Care AZ, P.C. —Remote
- From $20 an hour
- Contract
- Remote
- Mid-level
- Organizational skills
- LPN
- Paid training
- Opportunities for advancement
Quick Apply
Telehealth Nurse (LPN/LVN)
CopilotIQ —Atlanta, GA
- Full-time
- Remote
- Nursing
- Surgery
- RN License
- Work from home
Utilization Management Nurse, LVN/LPN
NeueHealth —Remote
- $26.35 - $39.53 an hour
- Remote
- Nursing
- LVN
- RN License
- Paid holidays
- Health insurance
Quick Apply
Clinical Review Nurse
TurningPoint Healthcare Solutions, LLC —Remote
- $52,000 - $68,000 a year
- Remote
- Nursing
- RN License
- Computer literacy
Quick Apply
Behavioral Health Clinical Specialist (LPN or RN)- Remote
Fast Pace Health —Franklin, TN
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
Fitness Minded RN or LPN
Balance Medical —Oklahoma
- $40 - $100 an hour
- PRN
- Remote
- Nursing
- RN License
- Mid-level
- Employee discount
- Professional development assistance
Quick Apply
5d
Nurse Health Coach
Linc Healthcare —Remote
- $25 - $30 an hour
- Choose your own hours
- Remote
- LVN
- RN License
- Clinic experience
- Work from home
Quick Apply
Remote Care Review Clinician (RN/LPN)- NY License required
Molina Healthcare, Inc. —Brooklyn, NY
- $24.00 - $56.17 an hour
- Full-time
- Remote
- Mid-level
- LPN
- 2 years
- Health insurance
Remote Home Health RN – Medical Claims Reviewer
Broadway Ventures —Remote
- $60,000 - $63,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Customer service
Quick Apply
Complex Medical Bill Reviewer
Enlyte —Remote
- $53,500 - $70,000 a year
- Full-time
- Remote
- Surgery
- LVN
- RN License
- Health savings account
- AD&D insurance
Call Center LPN - CareMount Clinical Team - Remote
Optum —Greensboro, NC
- $20 - $36 an hour
- Full-time
- Remote
- Pass drug screening
- HIPAA
- Mid-level
Quick Apply
3d
Med Mgmt Clinician (contract)
Elevance Health —Remote
- $25.44 - $48.58 an hour
- Contract
- Remote
- LVN
- RN License
- Mid-level
- Health savings account
- Disability insurance
Clinical Care Reviewer II (Remote)(Must Have - Unrestricted Massachusetts RN License)
CareSource —Remote
- $62,700 - $100,400 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook

I want to receive the latest job alert for Rn And Lpn's

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Utilization Specialist

RiverWoods Behavioral Health -
Riverdale, GA

Apply Now

Job Details

Part-time

Qualifications

CPR Certification
BLS Certification
High school diploma or GED

Full Job Description

Overview:

PURPOSE STATEMENT:

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.

Responsibilities:

ESSENTIAL FUNCTIONS:

Act as liaison between managed care organizations and the facility professional clinical staff.
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
Conduct quality reviews for medical necessity and services provided.
Facilitate peer review calls between facility and external organizations.
Initiate and complete the formal appeal process for denied admissions or continued stay.
Assist the admissions department with pre-certifications of care.
Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

OTHER FUNCTIONS:

Perform other functions and tasks as assigned.

Qualifications:

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

Required Education: High school diploma or equivalent.
Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred

LICENSES/DESIGNATIONS/CERTIFICATIONS:

Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
First aid may be required based on state or facility requirements.

ADDITIONAL REGULATORY REQUIREMENTS:

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.

We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

Apply Now

Refine Your Search

Rn And Lpn's jobs

Utilization Specialist

RN/LPN for Corporate Vaccinations and Health Screenings PRN

Call Center: Telecare Registered Nurse (RN) -Local Remote Role

LPN and RN ** Immediate work available

Utilization Review Nurse (RN)

Behavioral Health Care Manager (LPN/RN)

Licensed Appeal Writer - Remote

Patient Care Coordinator

Telehealth Nurse (LPN/LVN)

Utilization Management Nurse, LVN/LPN

Clinical Review Nurse

Behavioral Health Clinical Specialist (LPN or RN)- Remote

Fitness Minded RN or LPN

Nurse Health Coach

Remote Care Review Clinician (RN/LPN)- NY License required

Remote Home Health RN – Medical Claims Reviewer

Complex Medical Bill Reviewer

Call Center LPN - CareMount Clinical Team - Remote

Med Mgmt Clinician (contract)

Clinical Care Reviewer II (Remote)(Must Have - Unrestricted Massachusetts RN License)

I want to receive the latest job alert for Rn And Lpn's

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected