Reno, NV · On-site
... manager) as needed to ensure the appropriate and timely disposition of the client. The Utilization Management RN, documents all chart and phone reviews, identifies and communicates potentially ...
Reno, NV · On-site
... manager) as needed to ensure the appropriate and timely disposition of the client. The Utilization Management RN, documents all chart and phone reviews, identifies and communicates potentially ...
Reno, NV · On-site
... manager) as needed to ensure the appropriate and timely disposition of the client. The Utilization Management RN, documents all chart and phone reviews, identifies and communicates potentially ...
Reno, NV · On-site
... manager) as needed to ensure the appropriate and timely disposition of the client. The Utilization Management RN, documents all chart and phone reviews, identifies and communicates potentially ...
Reno, NV · On-site
$38.22 - $57.32/hr
... manager) as needed to ensure the appropriate and timely disposition of the client. The Utilization Management RN, documents all chart and phone reviews, identifies and communicates potentially ...
Reno, NV · On-site
$38.22 - $57.32/hr
... manager) as needed to ensure the appropriate and timely disposition of the client. The Utilization Management RN, documents all chart and phone reviews, identifies and communicates potentially ...
Sparks, NV · On-site
$155/hr
Facilitate safe and timely discharge planning in collaboration with social services, nursing, case management, and utilization review staff. * Coordinate ongoing medical maintenance care, collaborate ...
Sparks, NV · On-site
$155/hr
Facilitate safe and timely discharge planning in collaboration with social services, nursing, case management, and utilization review staff. * Coordinate ongoing medical maintenance care, collaborate ...
Reno, NV · On-site
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Reno, NV · On-site
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Reno, NV · On-site
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Reno, NV · On-site
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
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Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Dayton, NV · On-site
$17 - $21.50/hr
... utilization. * Review resource constraints such as material availability, labor capacity, and ... Perform other duties and assignments as directed by management to support plant operations and ...
Dayton, NV · On-site
$17 - $21.50/hr
... utilization. * Review resource constraints such as material availability, labor capacity, and ... Perform other duties and assignments as directed by management to support plant operations and ...
Reno, NV · On-site
$32.76 - $45.87/hr
Incumbent will also perform highly complex and specialized coding, including review analysis. The ... Adherence to Health Information Management (HIM) Coding policies. * Adherence to The Joint ...
Reno, NV · On-site
$32.76 - $45.87/hr
Incumbent will also perform highly complex and specialized coding, including review analysis. The ... Adherence to Health Information Management (HIM) Coding policies. * Adherence to The Joint ...
Reno, NV · Remote
Incumbent will also perform highly complex and specialized coding, including review analysis. The ... Adherence to Health Information Management (HIM) Coding policies. * Adherence to The Joint ...
Reno, NV · Remote
Incumbent will also perform highly complex and specialized coding, including review analysis. The ... Adherence to Health Information Management (HIM) Coding policies. * Adherence to The Joint ...
Reno, NV · Remote
Incumbent will also perform highly complex and specialized coding, including review analysis. The ... Adherence to Health Information Management (HIM) Coding policies. * Adherence to The Joint ...
Reno, NV · Remote
Incumbent will also perform highly complex and specialized coding, including review analysis. The ... Adherence to Health Information Management (HIM) Coding policies. * Adherence to The Joint ...
$51 - $56/hr
... utilization review, quality assurance, resident care conferences, admissions, department head meetings, and community education planning • Monitor and manage departmental revenue and expenses to ...
$51 - $56/hr
... utilization review, quality assurance, resident care conferences, admissions, department head meetings, and community education planning • Monitor and manage departmental revenue and expenses to ...
Carson City, NV · On-site
$51 - $56/hr
... utilization review, quality assurance, resident care conferences, admissions, department head meetings, and community education planning • Monitor and manage departmental revenue and expenses to ...
Carson City, NV · On-site
$51 - $56/hr
... utilization review, quality assurance, resident care conferences, admissions, department head meetings, and community education planning • Monitor and manage departmental revenue and expenses to ...
... utilization review, quality assurance, resident care conferences, admissions, department head meetings, and community education planning Monitor and manage departmental revenue and expenses to meet ...
... utilization review, quality assurance, resident care conferences, admissions, department head meetings, and community education planning Monitor and manage departmental revenue and expenses to meet ...
Reno, NV · On-site
Review foreign entity ledgers as needed. * Manage the process of maintaining the fixed asset ... utilization, and presentation. Must be proficient in MS Word, Excel, Power Point, and the use of ...
Reno, NV · On-site
Review foreign entity ledgers as needed. * Manage the process of maintaining the fixed asset ... utilization, and presentation. Must be proficient in MS Word, Excel, Power Point, and the use of ...
$38.9K - $50.5K
9% of jobs
$59.1K is the 25th percentile. Wages below this are outliers.
$50.5K - $62.2K
22% of jobs
$62.2K - $73.8K
11% of jobs
The median wage is $81K / yr.
$73.8K - $85.5K
14% of jobs
$85.5K - $97.1K
12% of jobs
$104.4K is the 75th percentile. Wages above this are outliers.
$97.1K - $108.8K
13% of jobs
$108.8K - $120.4K
13% of jobs
$120.4K - $132.1K
5% of jobs
$132.1K - $143.7K
2% of jobs
$143.7K - $155.4K
0% of jobs
$155.4K - $167K
0% of jobs
$38.9K
$90.7K
$167K
| Aspect | Manager Optum Utilization Review | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license, certifications in case management or utilization review | Registered Nurse (RN) license, certifications in case management or utilization review |
| Work Environment | Supervises teams, manages review processes, collaborates with healthcare providers | Conducts patient reviews, assesses medical necessity, documents findings |
| Employer & Industry Usage | Common in health insurance companies, managed care organizations, healthcare providers | Primarily in hospitals, insurance companies, healthcare organizations |
The main difference is that the Manager Optum Utilization Review oversees the review process and team management, while the Utilization Review Nurse focuses on conducting individual patient assessments and reviews. Both roles require nursing credentials and knowledge of healthcare policies, but the manager has additional responsibilities in leadership and process oversight.
7.5
Based on 97 frontline employees who took The Breakroom Quiz
233rd of 886 rated healthcare providers
Position Purpose
Under the supervision Hospital Care Management, incumbent promotes appropriate utilization, high quality care and cost effective outcomes. Incumbent is also responsible for utilization review, coordination of acute inpatient denials, performs admission and concurrent reviews and communication with physicians and payers regarding the medical necessity for services.
Nature and Scope
Conduct medical certification review for medical necessity for acute care facility and services. Use nationally recognized, evidence-based guidelines approved by medical staff to recommend level of care to the physician and serve as a resource to the medical staff on issues related to admission qualifications, resource utilization, national and local coverage determinations, and documentation improvement opportunities.
This position also provides information (certified LOS and reimbursement issues) to the care team (RN, physicians, and case manager) as needed to ensure the appropriate and timely disposition of the client.
The Utilization Management RN, documents all chart and phone reviews, identifies and communicates potentially avoidable/non-reimbursed days, quality indicators (such as readmissions). Delivers non-covered letters as set forth by payer and/or regulatory compliance.
This position will be required to work a flexible schedule that may include evenings and weekends to provide coverage for the department as needed. This position participates in Quality Improvement initiatives.
Knowledge, Skills & Abilities
1. Strong interpersonal communication skills both verbal and written.
2. Knowledge of applicable regulatory requirements and community resources
3. Knowledge of continuous quality improvement process.
4. Philosophy consistent with the strategic plan of Renown Health
5. The ability to understand and resolve complex problems in a timely and effective manner using critical thinking skills.
6. The ability to keep current with new developments and acquire the needed knowledge for the position in order to keep skill sets up to date.
7. The ability to work under stress and to meet deadlines.
This position does not provide patient care.
Disclaimer
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Minimum Qualifications
Requirements - Required and/or Preferred
Name
Description
Education:
Must have working-level knowledge of the English language, including reading, writing and speaking English. English. Appropriate education to obtain and maintain Registered Nursing licensure in the State of Nevada.
Experience:
Applicants with 1 year previous managed care and/or case management experience including acute hospital case management is preferred. Minimum of one-year in hospital setting required.
License(s):
Ability to obtain and maintain State of Nevada Registered Nurse license.
Certification(s):
Utilization or Case Management Certification preferred. Certification in Case Management (CCM), Certified Managed Care Nurse (CMCN), or ABQAURP HCQM is preferred.
Computer / Typing:
Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.
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Renown Health is a leading and respected player in the healthcare industry, based in Reno, NV, US. Established in 1862, the company has a deep-rooted history in providing high-quality healthcare services to the community. Renown Health offers a wide array of services including urgent care centers, lab services, x-ray and imaging services, primary care doctors and specialists. Its central values include excellence in quality and service, caring for people first, being proactive in the community, fiscal responsibility, integrity, and respecting every person.
Health care and social assistance
5,001 - 10,000 Employees
Reno, NV, US
1862
