Top 27 Rn Precertification/Concurrent Review Jobs

Behavioral Health Utilization Review Registered Nurse
Hines & Associates Inc —Rockford, IL
- $57,244 - $62,180 a year
- No weekends
- Hybrid work
- Nursing
- Addiction Medicine
- RN License
- Paid holidays
- Disability insurance
Quick Apply
Centralized Utilization Review Manager
Houston Methodist —Katy, TX
- Full-time
- Nursing
- RN License
- Hospital
2d
Intake Coordinator II/Float Therapist
SUN Behavioral Kentucky —Lexington, KY
- Full-time
- LMFT
- CPR Certification
- Writing skills
Intake Coordinator III
SUN Behavioral Houston —Houston, TX
- PRN
- CPR Certification
- RN License
- Writing skills
Manager Case Management & Social Services RN
Houston Methodist Willowbrook Hospital —Houston, TX
- Full-time
- Acute care
- Nursing
- RN License
2d
Med Mgmt Clinician (contract)
Elevance Health —Remote
- Contract
- Remote
- LVN
- RN License
- Mid-level
- Health savings account
- Disability insurance
Clinical Reviewer Nurse
Integrated Home Care Acquisition —Miramar, FL
- RN License
- Word processing
- Mid-level
- Paid training
- Wellness program
Quick Apply
Remote Intake Coordinator
SUN Behavioral Houston —Houston, TX
- PRN
- Remote
- Nursing
- RN License
- Writing skills
Registered Nurse (RN) Case Manager
Inova Health System —Fairfax, VA
- Part-time
- Acute care
- Nursing
- RN License
- Wellness program
- Paid parental leave
Intake RN Weekend Nights 7p-7:30a (NOT BAYLOR)
SUN Behavioral Kentucky —Erlanger, KY
- Part-time
- CPR Certification
- RN License
- Writing skills
RN - PSYCH
Aiken Regional Medical Centers —Aiken, SC
- Part-time
- Acute care
- Nursing
- RN License
- Health insurance
- Dental insurance
Nurse Case Manager I
International Medical Group —Remote
5d
Licensed Practical Nurse (LPN), FryeCare Cardiology
Frye Regional Medical Center —Hickory, NC
- Full-time
- Hospital
- BLS Certification
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Licensed Practical Nursing (LPN) New Grad Medical/Telemetry
Frye Regional Medical Center —Hickory, NC
- Full-time
- Acute care
- Hospital
- BLS Certification
- Disability insurance
- Health insurance
Quick Apply
RN - Registered Nurse - Utilization Review
UAB St. Vincent's —Birmingham, AL
- Monday to Friday
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Tuition reimbursement
14h
Manager Case Management
Houston Methodist Cypress Hospital —Cypress, TX
- Full-time
- Acute care
- Nursing
- RN License
14d

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Behavioral Health Utilization Review Registered Nurse

Hines & Associates Inc -
Rockford, IL

Quick Apply

Job Details

$57,244 - $62,180 a year

Benefits

Paid holidays
Disability insurance
Health insurance
Dental insurance
Vision insurance
401(k) matching
Life insurance

Qualifications

Customer communication
Customer service
Acute care

Full Job Description

Description:

Nurses – are you looking for a change? Want to work no nights, no weekends, and no holidays? Be able to work from home 50% of the time once trained? Check out Hines & Associates!

*Must have Mental Health and/or Substance Abuse experience*

ABOUT US:

Hines is a nationwide, independent leader in personalized managed health care, focused on what’s important to you—comprehensive services with the program excellence and cost containment that you demand. Hines & Associates, Inc.’s reputation as an industry leader is founded on over three decades of innovative and professional health care excellence. Serving all aspects of the industry, Hines is committed to conserving health care dollars while ensuring quality care through effective programs and personalized service.

WHAT WE OFFER:

Competitive salary and benefits, including medical, dental, vision, long-term care, short-term disability, long-term disability, company paid and voluntary life insurance. Critical Illness, accident insurance and flexible spending also available!
401k plan with company match, fully vested after 1 year.
No weekends and nights!
Paid Holidays
Work-life balance.
Remote/hybrid setting (once trained)

ROLE DESCRIPTION:

This individual will utilize clinical knowledge and communication skills to obtain patient specific information regarding patient condition and proposed treatments and procedures to determine if illness and/or proposed services meet acceptable criteria sets and acceptable nursing practice guidelines for outpatient treatment or inpatient confinement. This individual will certify treatment for confinement when criteria and/or practice guidelines are met, in accordance with the health benefit plan, disability, workers compensation regulations and state and federal regulations. If these conditions do not appear to be met, this individual will defer decision to a second level reviewer. This individual interfaces with case managers and disease management nurses on active cases involved in other Hines’ programs.

*****This is a Monday through Friday position, 9:30 AM to 6:00 PM.******

RESPONSIBILITIES AND PERFORMANCE:

Completes first level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review. General Medical-Surgical nursing is sufficient to be relevant to the clinical areas addressed in most initial clinical reviews. .
Demonstrates ability to assess a patient’s current medical status, including complications and untoward events, which may require additional intervention. Provides certification of medical, disability and workers compensation cases.
Demonstrates a thorough understanding of criteria sets and their limitations including when a second level review is required.
Evaluates appropriateness of current plan of care.
Assesses aftercare needs, implements discharge planning and/or case management referral in a timely manner.
Maintains knowledge of current advances and trends in medical care.
Demonstrates knowledge of URAC guidelines, Hines policies and procedures, and standards of practice and their revisions. Able to attain and maintain the minimal quality assurance performance standards.
Demonstrates assertiveness in completion of precertification and concurrent review within the guidelines of URAC, disability, workers compensation regulations, and state and federal requirements and according to the Hines policies and procedures.
Performs onsite evaluations as needed or requested.
Additional responsibilities as assigned.

PM21

COMMUNICATION:

Communicates with hospital staff, physicians, other providers and Hines customer contacts in a competent, calm, effective and professional manner.
Effectively communicates the need to refer to a higher-level review for questionable plans of treatment.
Provides written documentation concerning the clinical information obtained regarding the patient’s status, benefit and claim concerns, and validation of criteria.
Communicates knowledge of policies and procedures, URAC guidelines, disability and workers compensation regulations, state and federal requirements, and standards of practice.

PERSONAL AND PROFESSIONAL:

Participates in self-evaluation by identifying areas of strength and limitations and offers and accepts constructive criticism.
Creative and assertive.
All First Level Reviewers are required to sign and honor a confidentiality statement at the time of hire and annually at the time of performance reviews.

Requirements:

QUALIFICATIONS:

Registered Nurse with valid, unrestricted, current nursing license in the state or territory of the United States where employed. For mental health/substance abuse, licensed medical professional with an unrestricted license in the state or in a state that has licensure reciprocation with the state of the office location the employee is working in may perform first level reviews. Accepted licensure includes but is not limited to RN, LMSW, LMHC.
Must have Mental Health or Substance Abuse experience.
Successful completion of UR nurse orientation program.
Minimum of 3 years recent acute clinical practice required, 5 years preferred.
Managed care, disability or workers compensation experience helpful but not mandatory.
Customer service oriented.

*Hines welcomes diversity and as an equal opportunity employer all qualified applicants will be considered regardless of race, religion, color, national origin, sex, age, sexual orientation, gender identity, disability or protected veteran status.*

Quick Apply

Refine Your Search

Rn Precertification/Concurrent Review jobs

Behavioral Health Utilization Review Registered Nurse

Centralized Utilization Review Manager

Intake Coordinator II/Float Therapist

Intake Coordinator III

Manager Case Management & Social Services RN

Med Mgmt Clinician (contract)

Clinical Reviewer Nurse

Remote Intake Coordinator

Registered Nurse (RN) Case Manager

Intake RN Weekend Nights 7p-7:30a (NOT BAYLOR)

RN - PSYCH

Nurse Case Manager I

Licensed Practical Nurse (LPN), FryeCare Cardiology

Licensed Practical Nursing (LPN) New Grad Medical/Telemetry

RN - Registered Nurse - Utilization Review

Manager Case Management

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