This role blends clinical care, patient education, and case management. Key Responsibilities ... Flexible scheduling to manage your own caseload Requirements: * RN license in the state of practice
This role blends clinical care, patient education, and case management. Key Responsibilities ... Flexible scheduling to manage your own caseload Requirements: * RN license in the state of practice
... by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 ... Self-directed in goal setting for managing complex client situations.An ADN or Diploma in Nursing ...
... by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 ... Self-directed in goal setting for managing complex client situations.An ADN or Diploma in Nursing ...
... self-directed RN to manage Peritoneal Dialysis (PD) patients. You'll educate patients and ... This role blends clinical care, patient education, and case management. Key Responsibilities:
... self-directed RN to manage Peritoneal Dialysis (PD) patients. You'll educate patients and ... This role blends clinical care, patient education, and case management. Key Responsibilities:
Ensure that initial nursing treatment plans are completed upon admission and that all nursing treatment plans are specific to assessed needs. * Demonstrate knowledge and utilization of universal ...
Ensure that initial nursing treatment plans are completed upon admission and that all nursing treatment plans are specific to assessed needs. * Demonstrate knowledge and utilization of universal ...
Care Specialist (Nurse Educator)
San Juan, PR · On-site
$70K - $75K/yr
Assistance in the development of STAR-reviewed education plans covering a variety of topics ... Managing accounts and patients case-load in a large geography * Management of assigned travel and ...
Care Specialist (Nurse Educator)
San Juan, PR · On-site
$70K - $75K/yr
Assistance in the development of STAR-reviewed education plans covering a variety of topics ... Managing accounts and patients case-load in a large geography * Management of assigned travel and ...
Primary Care Physician - Relocation to Tucson, Arizona
San Juan, PR · On-site
$240K - $260K/yr
... social workers, case managers, and other health professionals. You'll participate in ... review, and special projects as required.- Adhere to HIPAA regulations and maintain the ...
Quick apply
Primary Care Physician - Relocation to Tucson, Arizona
San Juan, PR · On-site
$240K - $260K/yr
... social workers, case managers, and other health professionals. You'll participate in ... review, and special projects as required.- Adhere to HIPAA regulations and maintain the ...
Communicate therapeutically and professionally with patients, visitors, case managers, coworkers ... Current registered nursing license in State of facility required One year experience as a ...
Communicate therapeutically and professionally with patients, visitors, case managers, coworkers ... Current registered nursing license in State of facility required One year experience as a ...
Assistance in the development of STAR-reviewed education plans covering a variety of topics ... Managing accounts and patients case-load in a large geography * Management of assigned travel and ...
Assistance in the development of STAR-reviewed education plans covering a variety of topics ... Managing accounts and patients case-load in a large geography * Management of assigned travel and ...
Care Specialist (Nurse Educator) - San Juan, Puerto Rico (National)
San Juan, PR · On-site
$70K - $75K/yr
Assistance in the development of STAR-reviewed education plans covering a variety of topics ... Managing accounts and patients case-load in a large geography * Management of assigned travel and ...
Care Specialist (Nurse Educator) - San Juan, Puerto Rico (National)
San Juan, PR · On-site
$70K - $75K/yr
Assistance in the development of STAR-reviewed education plans covering a variety of topics ... Managing accounts and patients case-load in a large geography * Management of assigned travel and ...
PR · On-site
Completes initial interview with the patient; reviews and analyzes data collected in order to ... manages urgent patients, as well as implements the necessary actions in case of emergency or ...
Quick apply
PR · On-site
Completes initial interview with the patient; reviews and analyzes data collected in order to ... manages urgent patients, as well as implements the necessary actions in case of emergency or ...
Pharmacist Call Center - San Juan, PR
$57 - $68.75/hr
Utilize prescription claims data to generate clinical recommendations according to Medication Therapy Management and Retrospective Drug Utilization Review program protocols providing clinical ...
Pharmacist Call Center - San Juan, PR
$57 - $68.75/hr
Utilize prescription claims data to generate clinical recommendations according to Medication Therapy Management and Retrospective Drug Utilization Review program protocols providing clinical ...
... review in a production environment. Primary Responsibilities: * Clinical Case Reviews -75 ... Medical record coding experience with experience in Evaluation and Management Services in the ...
... review in a production environment. Primary Responsibilities: * Clinical Case Reviews -75 ... Medical record coding experience with experience in Evaluation and Management Services in the ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information ... Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information ... Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information ... Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information ... Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information ... Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information ... Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information ... Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information ... Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and ...
Network Operations Analyst
Guaynabo, PR · On-site
This role focuses on evaluating provider network adequacy, access to care, utilization trends, and ... Provides timely information to management regarding status of compliance with guidelines, rules ...
Network Operations Analyst
Guaynabo, PR · On-site
This role focuses on evaluating provider network adequacy, access to care, utilization trends, and ... Provides timely information to management regarding status of compliance with guidelines, rules ...
... reviews of Service Member health and dental records, interpret clinical findings (e.g., labs ... • Manage medical case files for Service Members who are not Fully Medically Ready (FMR ...
... reviews of Service Member health and dental records, interpret clinical findings (e.g., labs ... • Manage medical case files for Service Members who are not Fully Medically Ready (FMR ...
$41K - $78K/yr
Provide in-person clinical case support in cath labs and hospitals, ensuring proper use of Boston ... utilization, and clinical excellence. Educate physicians, fellows, nurses, and staff through ...
$41K - $78K/yr
Provide in-person clinical case support in cath labs and hospitals, ensuring proper use of Boston ... utilization, and clinical excellence. Educate physicians, fellows, nurses, and staff through ...
Manager, Program Management
San Juan, PR · On-site
This position supports clients with procurement documentation, environmental review coordination ... May oversee case management and other production staff Qualifications, Knowledge, Skills, and ...
Manager, Program Management
San Juan, PR · On-site
This position supports clients with procurement documentation, environmental review coordination ... May oversee case management and other production staff Qualifications, Knowledge, Skills, and ...
Case Manager Utilization Review Nurse information
What is a case manager utilization review nurse?
A Case Manager Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, coordinate with healthcare providers, and ensure that treatments meet established guidelines and insurance requirements. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulations. These nurses also help facilitate communication between patients, providers, and payers to support effective care management.
How does a case manager utilization review nurse typically collaborate with physicians and other healthcare providers?
Case Manager Utilization Review Nurses regularly work with physicians, social workers, and other healthcare professionals to ensure patients receive appropriate care while managing resource utilization. They often participate in interdisciplinary team meetings to discuss care plans, review patient progress, and address any barriers to discharge. Building strong communication channels and maintaining up-to-date clinical knowledge are essential, as nurses must advocate for patients while also supporting evidence-based practices and regulatory compliance. This collaborative environment helps streamline patient care and optimize outcomes.
What are the key skills and qualifications needed to thrive as a case manager utilization review nurse, and why are they important?
To excel as a Case Manager Utilization Review Nurse, you need a solid background in nursing, strong clinical assessment skills, and a valid RN license, often with case management certification. Familiarity with utilization review software, electronic health record (EHR) systems, and knowledge of insurance and regulatory guidelines is essential. Exceptional communication, critical thinking, and negotiation abilities set top performers apart in this role. These qualifications ensure effective patient advocacy, cost-effective care, and compliance with healthcare standards.
What is the difference between Case Manager Utilization Review Nurse vs Case Manager?
| Aspect | Case Manager Utilization Review Nurse | Case Manager |
|---|---|---|
| Credentials | RN license, certification in utilization review (e.g., URAC) | RN license, case management certification (e.g., CCM) |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, community health, insurance providers |
| Primary Focus | Reviewing medical necessity and appropriateness of care | Coordinating patient care and discharge planning |
While both roles involve patient care coordination, the Case Manager Utilization Review Nurse primarily focuses on reviewing medical necessity and insurance approvals, whereas the Case Manager handles broader patient care coordination and discharge planning. Both roles require nursing credentials and are vital in healthcare settings, but their specific responsibilities differ.
What are popular job titles related to Case Manager Utilization Review Nurse jobs in Puerto Rico?
For Case Manager Utilization Review Nurse jobs in Puerto Rico, the most frequently searched job titles are:
What job categories do people searching Case Manager Utilization Review Nurse jobs in Puerto Rico look for?
The top searched job categories for Case Manager Utilization Review Nurse jobs in Puerto Rico are:
- Remote Optum Utilization Review
- Fulltime Cigna Utilization Review Nurse
- Volunteer Aetna Utilization Review Nurse
- Full Time Cigna Utilization Review Nurse
- Remote Utilization Review
- Utilization Review
- Remote Utilization Review Manager
- Utilization Review Nurse Compact License
- Remote Rn Utilization Review Nurse
- Optum Utilization Review Nurse
What cities in Puerto Rico are hiring for Case Manager Utilization Review Nurse jobs?
Cities in Puerto Rico with the most Case Manager Utilization Review Nurse job openings:
Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 9 days ago
DaVita rating
7.0
Based on 1,175 frontline employees who took The Breakroom Quiz
414th of 887 rated healthcare providers
Job description
Posting Date
07/17/20263110 H G Mosley PkwySuite 100,Longview,Texas,75605-2941,United States of AmericaPeritoneal Dialysis Registered Nurse
Dialysis experience is preferred
Schedule: Monday - Friday 8-5
DaVita is seeking an organized, self-directed RN to manage Peritoneal Dialysis (PD) patients. You'll educate patients and caregivers in-clinic, enabling them to perform dialysis independently at home. This role blends clinical care, patient education, and case management.
Key Responsibilities:
- Train patients and caregivers on PD procedures and self-care
- Manage a caseload of PD patients, including assessments and care planning
- Monitor treatment progress, conduct home visits, and provide on-call support
- Collaborate with interdisciplinary teams to ensure safe, high-quality outcomes
Schedule:
- Monday-Friday, 8-hour shifts
- Weekends and holidays off
- Flexible scheduling to manage your own caseload
Requirements:
- RN license in the state of practice
- Valid driver's license, insurance, and reliable transportation
- ADN required; BSN preferred
- Basic computer skills (MS Word, Outlook)
Preferred Experience:
- Dialysis (PD, HHD, chronic, or acute)
- Patient education or teaching background
- Case management or telehealth experience
- CNN or CDN certification
What We Offer:
- Medical, dental, vision, and 401(k) match
- Paid time off and PTO cash-out
- Mental health and family support (EAP, Headspace, parental leave, etc.)
- Paid training and ongoing professional development
Empower patients to take control of their care. Make a meaningful impact-apply today.
#LI-MH2
At DaVita, we strive to be a community first and a company second. We want all teammates to experience DaVita as "a place where I belong." Our goal is to embed belonging into everything we do in our Village, so that it becomes part of who we are. We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements. Individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic.
This position will be open for a minimum of three days.
For location-specific minimum wage details, see the following link: DaVita.jobs/WageRates
Compensation for the role will depend on a number of factors, including a candidate's qualifications, skills, competencies and experience. DaVita offers a competitive total rewards package, which includes a 401k match, healthcare coverage and a broad range of other benefits. Learn more at https://careers.davita.com/benefits
Colorado Residents: Please do not respond to any questions in this initial application that may seek age-identifying information such as age, date of birth, or dates of school attendance or graduation. You may also redact this information from any materials you submit during the application process. You will not be penalized for redacting or removing this information.
About DaVita
Sourced by ZipRecruiter
DaVita is a healthcare company that provides compassionate, quality healthcare. The company’s mission is to be the Provider, Partner, and Employer of Choice. DaVita serves more than 200,000 dialysis patients in 10 countries outside the U.S. and has over 55,000 teammates in the U.S. Since 2011, DaVita teammates have donated $11 million to local nonprofits and have volunteered over 180,000 hours since 2006. DaVita has been on Fortune’s list of the world’s most admired companies for 15 years in a row.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Denver, CO, US
Year founded
1994