UTILIZATION REVIEW RN
Seymour, IN · On-site
Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing ... Utilization Review and Medical Necessity * Concurrent Review and Length of Stay Management
UTILIZATION REVIEW RN
Seymour, IN · On-site
Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing ... Utilization Review and Medical Necessity * Concurrent Review and Length of Stay Management
Registered Nurse Utilization Review
Carmel, IN · On-site +1
$50 - $52/hr
Minimum of 3 years hospital based bedside nursing experience in Med/Surg, ER, or critical care * Utilization Review OR Case Management experience required * Must live locally in Indiana Life at ...
Registered Nurse Utilization Review
Carmel, IN · On-site +1
$50 - $52/hr
Minimum of 3 years hospital based bedside nursing experience in Med/Surg, ER, or critical care * Utilization Review OR Case Management experience required * Must live locally in Indiana Life at ...
Registered Nurse Utilization Review
Carmel, IN · On-site
$84K/yr
Minimum of 3 years hospital based bedside nursing experience in Med/Surg, ER, or critical care * Utilization Review OR Case Management experience required * Must live locally in Indiana Equal ...
New
Registered Nurse Utilization Review
Carmel, IN · On-site
$84K/yr
Minimum of 3 years hospital based bedside nursing experience in Med/Surg, ER, or critical care * Utilization Review OR Case Management experience required * Must live locally in Indiana Equal ...
New
UTILIZATION REVIEW RN
Seymour, IN · On-site
Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing ... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing ... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical ...
Quick apply
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical ...
... Nurse in the state of Indiana. Must be current in BLS. Experience: Two years of hospital clinical experience. Knowledge of medical standards of care, state and federal utilization review laws, and ...
... Nurse in the state of Indiana. Must be current in BLS. Experience: Two years of hospital clinical experience. Knowledge of medical standards of care, state and federal utilization review laws, and ...
... Nurse in the state of Indiana. Must be current in BLS. Experience: Two years of hospital clinical experience. Knowledge of medical standards of care, state and federal utilization review laws, and ...
... Nurse in the state of Indiana. Must be current in BLS. Experience: Two years of hospital clinical experience. Knowledge of medical standards of care, state and federal utilization review laws, and ...
Utilization Review RN
Indianapolis, IN · On-site
$30 - $34/hr
Expected to review 20 cases a day with a 95% accuracy rate. Responsible for collaborating with ... Must have clear and active RN license in the state of IN * 2 years of experience in a acute care ...
Utilization Review RN
Indianapolis, IN · On-site
$30 - $34/hr
Expected to review 20 cases a day with a 95% accuracy rate. Responsible for collaborating with ... Must have clear and active RN license in the state of IN * 2 years of experience in a acute care ...
Utilization Review RN
Indianapolis, IN · On-site
... reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Qualifications * Must have clear and active RN license in the state of IN * AS ...
Utilization Review RN
Indianapolis, IN · On-site
... reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Qualifications * Must have clear and active RN license in the state of IN * AS ...
Cooperates and maintains good rapport with nursing staff, medical staff, and other departments ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Cooperates and maintains good rapport with nursing staff, medical staff, and other departments ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Cooperates and maintains good rapport with nursing staff, medical staff, and other departments ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Cooperates and maintains good rapport with nursing staff, medical staff, and other departments ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
Cooperates and maintains good rapport with nursing staff, medical staff, and other departments ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Cooperates and maintains good rapport with nursing staff, medical staff, and other departments ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
... thorough review of the total resources available to patient pre and post-discharge from ... N experience preferredHoursMonday - Friday (8:30am-5:00pm)This position is on-site at RHI The ...
Quick apply
... thorough review of the total resources available to patient pre and post-discharge from ... N experience preferredHoursMonday - Friday (8:30am-5:00pm)This position is on-site at RHI The ...
... oversees utilization management including, but not limited to: utilization review, case ... Must have Registered Nurse license or Master's Degree. Experience: 5-7 yrs acute inpatient ...
... oversees utilization management including, but not limited to: utilization review, case ... Must have Registered Nurse license or Master's Degree. Experience: 5-7 yrs acute inpatient ...
Reviewing patient admission clinical information using clinical criteria and guidelines available ... Facilitating discharge planning by working closely with Nurses and Clinical Social Workers and/or ...
Reviewing patient admission clinical information using clinical criteria and guidelines available ... Facilitating discharge planning by working closely with Nurses and Clinical Social Workers and/or ...
Utilization Review Np information
What does a utilization review nurse practitioner do?
A Utilization Review Nurse Practitioner (NP) evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance coverage to ensure that care meets established guidelines and regulatory requirements. Utilization Review NPs help coordinate care, prevent unnecessary procedures, and support cost-effective healthcare delivery while ensuring patient safety and quality outcomes.
What are some common challenges utilization review nurse practitioners face when collaborating with healthcare providers and insurance companies?
Utilization Review Nurse Practitioners often navigate the challenge of balancing patient advocacy with payer requirements. They must effectively communicate clinical justifications to both healthcare providers and insurance representatives, sometimes mediating disagreements over the necessity of certain treatments or hospital stays. Staying up-to-date with ever-changing insurance guidelines and ensuring timely documentation can also be demanding, but strong organizational and interpersonal skills help facilitate smooth collaboration and successful patient outcomes.
What are the key skills and qualifications needed to thrive as a utilization review nurse practitioner, and why are they important?
To thrive as a Utilization Review Nurse Practitioner (NP), you need expert clinical judgment, a strong understanding of healthcare regulations, and advanced assessment skills, typically supported by an active NP license and clinical experience. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines such as Medicare and Medicaid are commonly required. Excellent communication, attention to detail, and critical thinking are vital soft skills for effective case evaluations and collaboration with providers. These competencies ensure accurate, efficient reviews that support quality care, compliance, and cost-effective treatment decisions.
What is the difference between Utilization Review Np vs Utilization Review Nurse?
| Aspect | Utilization Review Np | Utilization Review Nurse |
|---|---|---|
| Credentials | Master's degree in Nursing, Nurse Practitioner certification, state licensure | Registered Nurse (RN) license, possibly with certification in utilization review |
| Work Environment | Healthcare facilities, insurance companies, utilization review organizations | Hospitals, insurance companies, outpatient clinics |
| Job Responsibilities | Assess medical necessity, authorize treatments, make clinical decisions, often with greater autonomy | Review medical records, support authorization processes, follow established guidelines |
Utilization Review NPs typically have advanced clinical training and greater decision-making authority compared to Utilization Review Nurses. Both roles focus on evaluating medical necessity, but NPs often perform more complex assessments and can make independent recommendations, whereas nurses support the review process under supervision or guidelines.
What are popular job titles related to Utilization Review Np jobs in Indiana?
For Utilization Review Np jobs in Indiana, the most frequently searched job titles are:
- Home Assessment Nurse Practitioner
- Internal Medicine Nurse Practitioner
- Work From Home Womens Health Nurse Practitioner
- Palliative Nurse Practitioner
- Mobile Nurse Practitioner
- Weekend Nurse Practitioner Walgreens
- Virtual Nurse Practitioner Home Assessments
- Hormone Nurse Practitioner
- Nurse Practitioner 3 Days A Week
- Longevity Nurse Practitioner
What job categories do people searching Utilization Review Np jobs in Indiana look for?
The top searched job categories for Utilization Review Np jobs in Indiana are:
What cities in Indiana are hiring for Utilization Review Np jobs?
Cities in Indiana with the most Utilization Review Np job openings:
Schneck Medical Center rating
7.2
Based on 14 frontline employees who took The Breakroom Quiz
424th of 1,064 rated hospitals
Job description
Job Details
SALARY / 8:00am - 5:00pm / with on-call, weekend, & holiday rotation required
ELIGIBLE FOR $2,000 SIGN-ON BONUS!
JOB REQUIREMENTS EDUCATION Minimum: Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing with case management certification
LICENSE/CERTIFICATION Licensed RN in State of Indiana. Certification plan in place within 24 months of hire.
EXPERIENCE Minimum: 2-3 years of acute care clinical experience Preferred: 3-5 years of acute care clinical experience with strong knowledge of medical necessity criteria and payer requirements
JOB DUTIES
- Utilization Review and Medical Necessity
- Concurrent Review and Length of Stay Management
- Retrospective Review
- Payer Communication & Authorization
- Denials Management and Appeals
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
What Schneck Medical Center employees say
Pay
Benefits
Hours and flexibility
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About Schneck Medical Center
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Seymour, IN, US
Year founded
1911