Additional Information All your information will be kept confidential according to EEO guidelines.
Additional Information All your information will be kept confidential according to EEO guidelines.
RN Utilization Mgmt
Washington, DC · On-site
$89.07K - $162.80K/yr
Responsible for clinical review of acute care services based on Medically Necessity criteria the ... utilization issues to appropriate MedStar personnel. Minimal Qualifications Education * Valid RN ...
RN Utilization Mgmt
Washington, DC · On-site
$89.07K - $162.80K/yr
Responsible for clinical review of acute care services based on Medically Necessity criteria the ... utilization issues to appropriate MedStar personnel. Minimal Qualifications Education * Valid RN ...
Case Manager/ Utilization Reviewer
$40.61 - $60.96/hr
Under general supervision, provides utilization review and denials management for an assigned ... Employment Type: FULL_TIME
Case Manager/ Utilization Reviewer
$40.61 - $60.96/hr
Under general supervision, provides utilization review and denials management for an assigned ... Employment Type: FULL_TIME
Case Manager/ Utilization Reviewer
Largo, MD · On-site
$40.61 - $60.96/hr
Under general supervision, provides utilization review and denials management for an assigned ... Work Experience Licensure Licensure as a Registered Nurse in the state of Maryland, or eligible to ...
Case Manager/ Utilization Reviewer
Largo, MD · On-site
$40.61 - $60.96/hr
Under general supervision, provides utilization review and denials management for an assigned ... Work Experience Licensure Licensure as a Registered Nurse in the state of Maryland, or eligible to ...
This role will be full-time Position. The Utilization Review Advisor (Advisor) position conducts ... The Advisor interfaces directly with UR nurses and medical staff, providing concurrent ...
This role will be full-time Position. The Utilization Review Advisor (Advisor) position conducts ... The Advisor interfaces directly with UR nurses and medical staff, providing concurrent ...
RN Utilization Management
Washington, DC · On-site
$89.07K - $162.80K/yr
Responsible for clinical review of acute care services based on Medically Necessity criteria the ... utilization issues to appropriate MedStar personnel. Minimal Qualifications Education * Valid RN ...
RN Utilization Management
Washington, DC · On-site
$89.07K - $162.80K/yr
Responsible for clinical review of acute care services based on Medically Necessity criteria the ... utilization issues to appropriate MedStar personnel. Minimal Qualifications Education * Valid RN ...
Claims Review Nurse (CERT)
Arlington, VA · On-site
Review claim documentation and associated medical records related to the CMS CERT program and ... Associate's, Diploma or Bachelor's degree in Nursing * 5 years of full-time work experience * 3 to ...
Claims Review Nurse (CERT)
Arlington, VA · On-site
Review claim documentation and associated medical records related to the CMS CERT program and ... Associate's, Diploma or Bachelor's degree in Nursing * 5 years of full-time work experience * 3 to ...
Claims Review Nurse (CERT)
Arlington, VA · On-site
Review claim documentation and associated medical records related to the CMS CERT program and ... Associate's, Diploma or Bachelor's degree in Nursing * 5 years of full-time work experience * 3 to ...
Claims Review Nurse (CERT)
Arlington, VA · On-site
Review claim documentation and associated medical records related to the CMS CERT program and ... Associate's, Diploma or Bachelor's degree in Nursing * 5 years of full-time work experience * 3 to ...
Clinical Review Coordinator
Annapolis Junction, MD · On-site
$83.20K/yr
Interprets and applies coverage and payment policies, standards of care, and utilization review ... Graduation from an accredited school of nursing and current unrestricted licensure as a Registered ...
Clinical Review Coordinator
Annapolis Junction, MD · On-site
$83.20K/yr
Interprets and applies coverage and payment policies, standards of care, and utilization review ... Graduation from an accredited school of nursing and current unrestricted licensure as a Registered ...
Director of Case Management
$120K - $130K/yr
Direct oversight of 5 full-time Case Managers, 1 Case Management Assistant, and 6 PRN staff ... Oversee utilization review and discharge planning processes * Ensure compliance with regulatory and ...
Quick apply
Director of Case Management
$120K - $130K/yr
Direct oversight of 5 full-time Case Managers, 1 Case Management Assistant, and 6 PRN staff ... Oversee utilization review and discharge planning processes * Ensure compliance with regulatory and ...
Director of Case Management
$120K - $130K/yr
Direct oversight of 5 full-time Case Managers, 1 Case Management Assistant, and 6 PRN staff ... Oversee utilization review and discharge planning processes * Ensure compliance with regulatory and ...
Quick apply
Director of Case Management
$120K - $130K/yr
Direct oversight of 5 full-time Case Managers, 1 Case Management Assistant, and 6 PRN staff ... Oversee utilization review and discharge planning processes * Ensure compliance with regulatory and ...
... utilization review discharge planning outcomes management transitional planning assessment care planning and service implementation SSN Required DOB Required Work History: Should not be more than 30 ...
... utilization review discharge planning outcomes management transitional planning assessment care planning and service implementation SSN Required DOB Required Work History: Should not be more than 30 ...
Quality Analyst (Remote, LPN Required)
Washington, DC · Remote
$45K - $70K/yr
The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment ...
Quality Analyst (Remote, LPN Required)
Washington, DC · Remote
$45K - $70K/yr
The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment ...
Licensed RN * Minimum of 7 years of experience with utilization review, clinical pathways, case management, and disease management * 3 years of experience in a management capacity role * Requires ...
Quick apply
Licensed RN * Minimum of 7 years of experience with utilization review, clinical pathways, case management, and disease management * 3 years of experience in a management capacity role * Requires ...
Licensed RN * Minimum of 7 years of experience with utilization review, clinical pathways, case management, and disease management * 3 years of experience in a management capacity role * Requires ...
Licensed RN * Minimum of 7 years of experience with utilization review, clinical pathways, case management, and disease management * 3 years of experience in a management capacity role * Requires ...
Description: The Nurse Educator/Review Coordinator's primary role is to facilitate provider ... utilization reviews preferred. Essential Skills: * Ability to organize and coordinate multiple ...
Description: The Nurse Educator/Review Coordinator's primary role is to facilitate provider ... utilization reviews preferred. Essential Skills: * Ability to organize and coordinate multiple ...
Licensed RN * Minimum of 7 years of experience with utilization review, clinical pathways, case management, and disease management * 3 years of experience in a management capacity role * Requires ...
Licensed RN * Minimum of 7 years of experience with utilization review, clinical pathways, case management, and disease management * 3 years of experience in a management capacity role * Requires ...
Care Navigator RN, Day Shift, Care Navigation
Fort Washington, MD · On-site
$77.31K - $115.98K/yr
... Communicates with Utilization Review staff on any denials, issues or barriers to discharge ... Employment Type: Full-time Hours per Week: 40 hrs/week Typical Daily Schedule: 8:00 AM-4:30 PM ...
Care Navigator RN, Day Shift, Care Navigation
Fort Washington, MD · On-site
$77.31K - $115.98K/yr
... Communicates with Utilization Review staff on any denials, issues or barriers to discharge ... Employment Type: Full-time Hours per Week: 40 hrs/week Typical Daily Schedule: 8:00 AM-4:30 PM ...
Licensed RN * Minimum of 7 years of experience with utilization review, clinical pathways, case management, and disease management * 3 years of experience in a management capacity role * Requires ...
Licensed RN * Minimum of 7 years of experience with utilization review, clinical pathways, case management, and disease management * 3 years of experience in a management capacity role * Requires ...
Clinical, Supervisor
Mclean, VA · Remote
... - Full-time, this individual plays a pivotal role in overseeing and managing the Utilization ... Conduct utilization reviews as needed to support workload demands and program requirements.
New
Clinical, Supervisor
Mclean, VA · Remote
... - Full-time, this individual plays a pivotal role in overseeing and managing the Utilization ... Conduct utilization reviews as needed to support workload demands and program requirements.
New
Full Time Aetna Utilization Review Nurse information
What are the key skills and qualifications needed to thrive as a Full Time Aetna Utilization Review Nurse, and why are they important?
To thrive as a Full Time Aetna Utilization Review Nurse, you need an active RN license, strong clinical assessment skills, and experience with case management or utilization review. Familiarity with utilization management software, InterQual or Milliman criteria, and electronic medical record systems is typically required. Exceptional critical thinking, attention to detail, and effective communication skills help in collaborating with healthcare teams and advocating for patient needs. These skills ensure appropriate care utilization, regulatory compliance, and optimal patient outcomes within the insurance and healthcare framework.
How does a Full Time Aetna Utilization Review Nurse typically collaborate with physicians and case managers to ensure optimal patient care?
As a Full Time Aetna Utilization Review Nurse, you will regularly interact with physicians and case managers to review patient cases, verify the medical necessity of treatments, and ensure that care plans meet established guidelines. Collaboration often involves discussing complex cases, clarifying documentation, and coordinating care transitions. Effective communication and teamwork are essential, as you help balance quality patient outcomes with cost-effective healthcare delivery while maintaining compliance with industry regulations.
What does a Full Time Aetna Utilization Review Nurse do?
A Full Time Aetna Utilization Review Nurse is responsible for reviewing medical records and clinical information to determine the medical necessity and appropriateness of healthcare services for Aetna members. They assess treatment plans, coordinate with providers, and ensure that care aligns with established guidelines and insurance policies. These nurses work to ensure patients receive quality care while helping to manage healthcare costs and prevent unnecessary procedures. Their role involves frequent communication with healthcare providers, patients, and insurance team members.
What is the difference between Full Time Aetna Utilization Review Nurse vs Full Time Aetna Case Manager?
| Aspect | Full Time Aetna Utilization Review Nurse | Full Time Aetna Case Manager |
|---|---|---|
| Certifications | RN license, possibly certifications in utilization review | RN license, case management certification often preferred |
| Work Environment | Hospitals, clinics, insurance companies focusing on review processes | Insurance companies, healthcare settings managing patient care plans |
| Job Focus | Assessing medical necessity for services and procedures | Coordinating patient care, discharge planning, and resource management |
| Common Usage | Used in insurance and healthcare for review roles | Used in insurance and healthcare for patient management roles |
While both roles require healthcare knowledge and RN licensure, the Full Time Aetna Utilization Review Nurse primarily evaluates the necessity of medical services, whereas the Full Time Aetna Case Manager focuses on coordinating patient care and discharge planning. Both positions are integral to healthcare insurance operations but differ in daily responsibilities and focus areas.
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Job description
Additional Information
All your information will be kept confidential according to EEO guidelines.
About Korak Healthsource Group
Sourced by ZipRecruiter
Korak Healthsource Group Inc., looks beyond today’s challenges and creates values for the future. Today’s Claims Management clients need the organizational flexibility for all staffing solutions to drive cost savings, efficiencies improvements and enhancement to process effectiveness. Korak Healthsource is dedicated to developing innovative partnerships, creating customized staffing solutions, cost-effective and efficient health care claims administration outsourcing and support services to meet your business goals. Our focus is on your business goals to drive business process improvement, solution effectiveness and technology enhancements to accelerate results.
Industry
Recruiting and staffing services
Company size
11 - 50 Employees
Headquarters location
Forest Hill, MD, US
Year founded
1996