Entry Level Anthem Utilization Review Nurse Jobs

Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques ...

Refers to UR committee any case that surpasses expected LOS, expected cost, or over/under-utilization of resources. * Performs verbal/fax clinical review with payer as determined by nursing judgment ...

One year Utilization Review or Case Management experience. Licenses Required * Current license to practice as a Registered Nurse in the State of Utah, or obtain one within 90 days of hire under the ...

Utilization Review Nurse Job Summary The Utilization Nurse is responsible for conducting prospective, concurrent, and retrospective clinical reviews to determine medical necessity, level of care, and ...

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant hospital nursing; hospital case management; insurance case ...

Refers to UR committee any case that surpasses expected LOS, expected cost, or over/under-utilization of resources. * Performs verbal/fax clinical review with payer as determined by nursing judgment ...

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant hospital nursing; hospital case management; insurance case ...

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant hospital nursing; hospital case management; insurance case ...

... nursing professionalism, teamwork, and superiority in patient care. Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with third ...

Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties*** RN working ... This position is responsible for performing initial, concurrent review activities; discharge care ...

Are you an experienced RN Utilization Review Nurse looking for a new opportunity with a prestigious healthcare company as a RN Utilization Review Nurse. Do you want the chance to advance your career ...

Refers to UR committee any case that surpasses expected LOS, expected cost, or over/under-utilization of resources. * Performs verbal/fax clinical review with payer as determined by nursing judgment ...

... nursing professionalism, teamwork, and superiority in patient care. Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with third ...

Serves as the Utilization Review Nurse and assists in quality improvement activities through data collection, monitoring the quality of processes that impact patient safety, appropriateness of care ...

Refers to UR committee any case that surpasses expected LOS, expected cost, or over/under-utilization of resources. * Performs verbal/fax clinical review with payer as determined by nursing judgment ...

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant hospital nursing; hospital case management; insurance case ...

Qualifications Associates RN degree required, Bachelor's degree preferred Two years of experience in managed care quality assurance or utilization review RN must have two years of experience in an ...

Cases are presented to the Utilization Review to recommend the committee to determine if a second ... Determined by the Maryland State Board of Nursing under the licensing requirements for Registered ...

Serves as mentor/trainer to new RN's and other staff as needed, completes audits, reviews and ... Understands fiscal accountability and its impact on the utilization of resources, proceeding to ...

Job Summary Our client is seeking a Utilization Review Nurse. This role involves managing the full lifecycle of Independent Review Organization (IRO) cases, ensuring compliance with regulatory ...