Top 8487 Rn Utilization Management Jobs

Utilization Review Nurse
University Medical Center of Southern Nevada —Las Vegas, NV
- $40.72 - $63.12 an hour
- Weekends as needed
- Nursing
- RN License
- Office
- Health insurance
- Dental insurance
Quick Apply
Utilization Management Nurse
TEXAS INDEPENDENCE HEALTH PLAN INC —Austin, TX
- Weekends as needed
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
RN Utilization Management
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Vision insurance
Pool Utilization Review Registered Nurse, Case Management, Per Diem,Shift Varies (Rotating Weekends)
Baptist Health South Florida —Boca Raton, FL
- $47 an hour
- Rotating weekends
- Nursing
- RN License
- Mid-level
- Wellness program
- Health insurance
11d
Utilization Management Coordinator
Riveredge Hospital —Forest Park, IL
- $30 - $46 an hour
- Full-time
- Writing skills
- Medical office experience
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
1d
RN - Utilization Review / Quality Improvement
Whitecap Search —Brooklyn, NY
- $135,000 - $145,000 a year
- Nursing
- RN License
- Hospital
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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
Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
- Nursing
Quick Apply
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
Utilization Management Registered Nurse
Humana —South Carolina
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
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
3d
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
11d
Utilization Review RN
Providence —Mission Hills, CA
- $57.28 - $88.92 an hour
- Per diem
- Hybrid work
- Nursing
- RN License
- Medical office experience
- Paid parental leave
- Paid holidays
RN - Utilization Management
Piedmont Healthcare Inc. —Atlanta, GA
- Full-time
- Remote
- Nursing
- RN License
- Bachelor of Science
2d
Utilization Review RN - Case Management
Swedish Health Services —Seattle, WA
- $52.26 - $81.13 an hour
- Day shift
- Nursing
- RN License
- Hospital
- Paid parental leave
- Paid holidays
Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
Quick Apply
RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare —California
- $30.37 - $59.21 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Discharge planning
- Health insurance
Utilization Management RN (Hybrid)
TEXASCONNECT INC —Dallas, TX
- Weekends as needed
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Relocation assistance
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
9d
Clinical Review and Appeals Specialist
Life Care Centers of America —Cleveland, TN
- Weekends as needed
- Nursing
- RN License
- Customer service
- Health insurance
- Dental insurance
Quick Apply

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Utilization Review Nurse

University Medical Center of Southern Nevada -
Las Vegas, NV

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Job Details

Full-time
$40.72 - $63.12 an hour

Benefits

Health insurance
Dental insurance
Paid time off
Pension plan
Vision insurance
Life insurance
Retirement plan

Qualifications

TJC
Nursing
Inpatient experience
Utilization review
Electronic health records (EHR) management
RN License
Investigative interviewing techniques
Medical software
Acute care facility experience
EMR/EHR
Health insurance knowledge
InterQual
Case management
Utilization management
Clinical documentation
Discharge planning
Computer skills
Milliman Care Guidelines (MCG Health)
Clinical documentation standards
Nursing

Full Job Description

EMPLOYER-PAID PENSION PLAN (NEVADA PERS)
COMPETITIVE SALARY & BENEFITS PACKAGEAs an academic medical center with a rich history of providing life-saving treatment in Southern Nevada, UMC serves as the anchor hospital of the Las Vegas Medical District, offering Nevada’s highest level of care to promote successful medical outcomes for patients.

We are home to Nevada's ONLY Level I Trauma Center, Designated Pediatric Trauma Center, Burn Care Center, and Transplant Center. We are a Pathway Designated facility by ANCC, and we are on our journey to Magnet status.
Position Summary:Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with third party payer requirements. Duties include analyzing medical charts, determining whether care provided is within established parameters.

Job Requirement

Education/Experience:
Graduation from an accredited school of nursing and five (5) years of acute hospital clinical nursing experience, one (1) year of which was in Utilization Management, Case Management, or Clinical Documentation Improvement.

Licensing/Certification Requirements:
Valid license by the State of Nevada to practice as a Registered Nurse.

Additional Position Requirements

Minimum three (3) years of Utilization Management experience.
Minimum of three (3) year's experience with discharge planning in an acute care facility.
Recent documented experience with InterQual, and ability to pass the InterQual exam.
Recent documented experience with Milliman experience.

Knowledge, Skills, Abilities, and Physical Requirements

Knowledge of:
Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies and procedures; Joint Commission Accredited Health care Organizations standards, state statutes governing hospital services and health care, and other relevant regulations and standards; clinical medical and nursing procedures; disease processes; department and hospital safety practices and principles; patient rights; age specific patient care practices; infection control policies and practices; department and hospital emergency response policies and procedures.

Skill in:
Interpreting patient charts to determine whether care given is within best practice, appropriate for the diagnosis and properly documented; excellent ability to collaborate, co-ordinate and communicate findings; interpreting regulations and standards for others; writing reports, meeting minutes and other technical documents; analyzing statistical and other quantitative data; applying investigative and interviewing techniques; using a computer and a variety of software applications; communicating with a wide variety and establishing interpersonal relationships to interact effectively with co-workers, supervisor, staff in other work units and exchange or convey information.

Physical Requirements and Working Conditions:
Mobility to work in a typical office setting and use standard equipment, stamina to remain seated for extended periods of time, vision to read printed materials and a computer screen, and hearing and speech to communicate effectively in person and over the telephone. Strength and agility to exert up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. May work shifts and weekends. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this classification.

Job Type: Full-time

Pay: $40.72 - $63.12 per hour

Benefits:

Dental insurance
Health insurance
Life insurance
Paid time off
Retirement plan
Vision insurance

Experience:

acute hospital clinical nursing: 5 years (Required)
Utilization Management: 3 years (Required)
InterQual, and ability to pass the InterQual exam: 1 year (Required)
Milliman: 1 year (Required)

License/Certification:

Registered Nurse License by the State of NV. (Required)

Work Location: In person

Quick Apply

Refine Your Search

Rn Utilization Management jobs

Utilization Review Nurse

Utilization Management Nurse

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Pool Utilization Review Registered Nurse, Case Management, Per Diem,Shift Varies (Rotating Weekends)

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Concurrent Utilization Review Nurse, RN

Utilization Management Nurse

Remote Home Health RN – Medical Claims Reviewer

Utilization Management Registered Nurse

RN - Utilization Management - MGH

Denials & Appeals Administrator (RN)

Utilization Review RN

RN - Utilization Management

Utilization Review RN - Case Management

Claims - Care Manager, RN, Claims

RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)

Utilization Management RN (Hybrid)

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

Clinical Review and Appeals Specialist

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