Top 14 Utilization review nurse Jobs in Olive Branch, Ms

Part Time Utilization Specialist
Crestwyn Behavioral Health —Germantown, TN
- Part-time
- CPR Certification
- Nursing
- RN License
RN-Case Manager
Baptist Memorial Health Care —Southaven, MS
- Nursing
- RN License
- Mid-level
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 PRN
Baptist Memorial Health Care —Memphis, TN
- PRN
- Nursing
- RN License
- Mid-level
RN-Acute Care Case Manager
Baptist Memorial Health Care —Memphis, TN
- Acute care
- Nursing
- RN License
RN-Acute Care Case Manager PRN Weekends
Baptist Memorial Health Care —Memphis, TN
- Weekends as needed
- 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
13d
Travel Case Management RN
Fastaff —United States
- Up to $2,826 a week
- Full-time
- Background check
- Nursing
- RN License
- Mileage reimbursement
- Health savings account
Quick Apply
7d
Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- LVN
- RN License
- Mid-level
- Travel reimbursement
- Health savings account
Quick Apply

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REGISTERED NURSE CASE MANAGER / RN CASE MANAGER
Spring Valley Hospice —Olive Branch, MS
Graduate of an accredited nursing school with current licensure to practice in state of operation. Ensure compliance with all state and federal legal and…

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Utilization Review Specialist - Autism
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Part Time Utilization Specialist

Crestwyn Behavioral Health -
Germantown, TN

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.

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Refine Your Search

utilization review nurse jobs in olive branch, ms

Part Time Utilization Specialist

RN-Case Manager

Discharge Planner/RN

Case Mgr/RN

RN-Case Manager PRN

RN-Acute Care Case Manager

RN-Acute Care Case Manager PRN Weekends

Family Nurse Practitioner / Physician Assistant

Travel Case Management RN

Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license

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