Top 7087 Rn Utilization Management Jobs

RN Utilization Management
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Vision insurance
Utilization Management Nurse
TEXAS INDEPENDENCE HEALTH PLAN INC —Austin, TX
- Weekends as needed
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
RN Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
RN Case Manager - Surgery Services
UCLA Health —Los Angeles, CA
- $65.53 - $84.75 an hour
- Nursing
- Surgery
- RN License
RN Team Lead Utilization Review
MedStar Health —Clinton, MD
- $89,065 - $162,801 a year
- Full-time
- Nursing
- RN License
- Inpatient
2d
Clinical Review Nurse
TurningPoint Healthcare Solutions, LLC —Remote
- $52,000 - $68,000 a year
- Remote
- Nursing
- RN License
- Computer literacy
Quick Apply
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
10d
Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
- Nursing
Quick Apply
Denials & Appeals Administrator (RN)
Boston Medical Center —Remote
- $43.03 - $62.50 an hour
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Health insurance
- Dental insurance
12d
Concurrent Utilization Review Nurse, RN
NeueHealth —Los Angeles, CA
- $74,286.15 - $111,429.23 a year
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Pre-Authorization RN - $15,000 Sign-On Bonus or Student Loan Assistance!
MJHS —New York, NY
- $90,000 - $110,000 a year
- Microsoft Word
- Nursing
- RN License
Quick Apply
RN Quality Reviewer Home Health Per Diem
Patients First Home Care LLC —Remote
- $31 - $36 an hour
- Full-time
- Remote
- Background check
- CPR Certification
- Current TB test
- Continuing education credits
- Health insurance
Quick Apply
RN - Utilization Management - MGH
The General Hospital Corporation —Boston, MA
- $41.72 - $105.65 an hour
- Part-time
- Remote
- RN License
- Mid-level
- Experience equivalent to degree accepted
- Opportunities for advancement
Quick Apply
4d
Case Manager, Registered Nurse (Oncology experience required)
CVS Health —California
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
INDEPENDENT REVIEW NURSE
iMPROve Health (MPRO) —Remote
- $34 - $42 an hour
- Part-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Disability insurance
- Health insurance
Quick Apply
4d
Utilization Management Registered Nurse
Humana —Arizona
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Medical & Disability Nurse Case Manager
Liberty Mutual —Remote
- $67,000 - $126,000 a year
- Full-time
- Remote
- Spanish
- Nursing
- Microsoft Excel
Telehealth Triage Registered Nurse (RN)
Lumina Care —Remote
- $38 - $45 an hour
- Weekends as needed
- Remote
- Nursing
- Psychiatry
- RN License
- Paid holidays
- Health insurance
Quick Apply
RN, Care Manager, Utilization Management (Part-time, Every weekend - Remote)
Adventist Health —Roseville, CA
- $59.23 - $81.24 an hour
- Part-time
- Remote
- Nursing
- RN License
- Mid-level
12d
Med Mgmt Nurse (contract)
Elevance Health —Remote
- $32.35 - $61.78 an hour
- Contract
- Remote
- Nursing
- RN License
- Mid-level
- Health savings account
- Disability insurance
12d

I want to receive the latest job alert for Rn Utilization Management

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

Explore jobs in more locations

Rn Utilization Management jobs near

RN Utilization Management

MedStar Health -
Washington, DC

Apply Now

Job Details

Full-time
$89,065 - $162,801 a year

Benefits

Vision insurance

Qualifications

RN License
Utilization management

Full Job Description

About this Job:

General Summary of Position
The RN Utilization Manager will have 1-2 years of Utilization review- responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of acute care services based on Medically Necessity criteria the management of quality health care resources for achievement of desired outcomes and coordination of alternative levels of care in a timely and in the most cost-effective manner.We recruit retain and advance associates with diverse backgrounds skills and talents equitably at all levels.

Primary Duties and Responsibilities

Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Acts as a liaison to MedStar Family Choice (MFC) contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care.
Acts as an advocate while assisting members to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy.
Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups etc. as assigned. Provides input completes assignments and shares new findings with other staff. Participates in meetings and on committees and represents the department and MFC in community outreach efforts. Participates in multi-disciplinary quality and service improvement teams.
Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
Demonstrates skill and flexibility in providing coverage for other staff.
Identifies inpatients requiring additional services and initiates care with appropriate providers. Demonstrates emphasis on quality patient care during the pre-admission and/or concurrent review process. Authorizes services according to MedStar Family Choice policy.
Initiates contact with providers to obtain clinical information to facilitate approval or pending of pre-authorization requests inpatient stays and retrospective reviews.
Maintains current knowledge of MFC benefits and enrollment issues in order to accurately coordinate services.
Maintains timely and accurate documentation in the clinical software system per Clinical Operations department's policy.
Monitors utilization of all services for fraud and abuse.
Performs pre-authorization and pharmacy reviews and documents in PBMÆs system when assigned.
Performs telephonic ACD line coverage for Clinical Operations' needs.
Performs telephonic inpatient utilization review services; on-site review as indicated. Process includes: assessment planning coordinating and implementation. Monitors for timely provision of services. Assists hospital case management staff with discharge planning as applicable.
Makes referrals to Case Management as needed.
Sends thorough reviews to Medical Director as appropriate. Coordinates timely review decisions and notifications per policy NCQA standards/guidelines and District of Columbia Contract.
Utilizes evidence-based standards in making coverage determinations in individual patient cases; Identifies and reports potential coordination of benefits subrogation third party liability worker's compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel.

Minimal Qualifications
Education

Valid RN license in the District of Columbia; or Maryland required and
Bachelor's degree preferred

Experience

1-2 years Recent utilization experience required and
1-2 years Diverse clinical experience required

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia; or Maryland Upon Hire required and
CCM - Certified Case Manager CCM (Certified Case Manager) Upon Hire preferred

Knowledge Skills and Abilities

Proficient computer skills to enter and retrieve data.
Ability to create edit and analyze Microsoft office (Word Excel and PowerPoint) preferred.
Knowledge of InterQual guidelines preferred.

This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr.

Apply Now

Refine Your Search

Rn Utilization Management jobs

RN Utilization Management

Utilization Management Nurse

RN Case Manager

RN Case Manager - Surgery Services

RN Team Lead Utilization Review

Clinical Review Nurse

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

Utilization Management Nurse

Denials & Appeals Administrator (RN)

Concurrent Utilization Review Nurse, RN

Pre-Authorization RN - $15,000 Sign-On Bonus or Student Loan Assistance!

RN Quality Reviewer Home Health Per Diem

RN - Utilization Management - MGH

Case Manager, Registered Nurse (Oncology experience required)

INDEPENDENT REVIEW NURSE

Utilization Management Registered Nurse

Medical & Disability Nurse Case Manager

Telehealth Triage Registered Nurse (RN)

RN, Care Manager, Utilization Management (Part-time, Every weekend - Remote)

Med Mgmt Nurse (contract)

I want to receive the latest job alert for Rn Utilization Management

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected