Top 11 Utilization review nurse Jobs in Memphis Tn

Part Time Utilization Specialist
Crestwyn Behavioral Health —Germantown, TN
- Part-time
- CPR Certification
- Nursing
- RN License
Discharge Planner/RN
REGIONAL ONE HEALTH —Memphis, TN
- Full-time
- Nursing
- RN License
- HIPAA
Case Mgr/RN
REGIONAL ONE HEALTH —Memphis, TN
- PRN
- Nursing
- Hospital
- HIPAA
RN-Case Manager
Baptist Memorial Health Care —Southaven, MS
- Nursing
- RN License
- Mid-level
RN-Case Manager PRN
Baptist Memorial Health Care —Memphis, TN
- PRN
- Nursing
- RN License
- Mid-level
RN-Acute Care Case Manager PRN Weekends
Baptist Memorial Health Care —Memphis, TN
- Weekends as needed
- Acute care
- Nursing
- RN License
RN-Acute Care Case Manager
Baptist Memorial Health Care —Memphis, TN
- Acute care
- Nursing
- RN License
Family Nurse Practitioner / Physician Assistant
Davis Family Medicine —Hernando, MS
- Part-time
- Urgent Care
- Primary Care
- Mid-level
- Health insurance
- Paid time off
Quick Apply
Utilization Management Reviewer
Amerihealth Caritas —United States
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Health insurance

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Discharge Planner/RN
REGIONAL ONE HEALTH —Memphis, TN
Coordinates with clinical and social service providers across traditional and nontraditional settings including, but not limited to hospitals, primary care…
Clinical Liaison (CL) Inpatient Rehabilitation
Baptist Memorial Rehabilitation Hospital —Germantown, TN
Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
Quick Apply
10d

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Case Manager (RN) - Full-Time
OhioHealth Rehabilitation Hospital —Columbus, OH
Current Licensure per state guidelines in clinical or related discipline OR a Bachelor's or Master's in a health or human services discipline.
$70,000 - $84,000 a year
Quick Apply
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Case Manager / PRN ( RN / RT / SW / LPN )
Select Specialty Hospital - Columbus Vic Village(Grant) —Columbus, OH
Current licensure in a clinical discipline either as a Nurse (RN /LPN/ LVN)or a Respiratory Therapist OR current license / certified Social Work license per…
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Part Time Utilization Specialist

Crestwyn Behavioral Health -
Germantown, TN

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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

utilization review nurse jobs in memphis tn

Part Time Utilization Specialist

Discharge Planner/RN

Case Mgr/RN

RN-Case Manager

RN-Case Manager PRN

RN-Acute Care Case Manager PRN Weekends

RN-Acute Care Case Manager

Family Nurse Practitioner / Physician Assistant

Utilization Management Reviewer

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