For Nursing, must possess bachelor's degree in nursing (BSN) with RN licensure. * For other ... Three years of hospital-based Case Management experience, including Utilization Review and ...
For Nursing, must possess bachelor's degree in nursing (BSN) with RN licensure. * For other ... Three years of hospital-based Case Management experience, including Utilization Review and ...
(RN)Auditor, Healthcare Services - NCQA
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
Albuquerque, NM · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
Albuquerque, NM · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
RN CASE MANAGER
Corrales, NM · On-site
$35.56 - $50.48/hr
Utilization Management *SRMC Care Management *Full Time *Part Time Receive 17% Weekday Nights, 26 ... This is supported by a chart review for the level of care and correcting billing aspects of care ...
RN CASE MANAGER
Corrales, NM · On-site
$35.56 - $50.48/hr
Utilization Management *SRMC Care Management *Full Time *Part Time Receive 17% Weekday Nights, 26 ... This is supported by a chart review for the level of care and correcting billing aspects of care ...
RN CASE MANAGER
Albuquerque, NM · On-site
Utilization Management *SRMC Care Management *Full Time *Part Time Receive 17% Weekday Nights, 26 ... This is supported by a chart review for the level of care and correcting billing aspects of care ...
RN CASE MANAGER
Albuquerque, NM · On-site
Utilization Management *SRMC Care Management *Full Time *Part Time Receive 17% Weekday Nights, 26 ... This is supported by a chart review for the level of care and correcting billing aspects of care ...
RN CASE MANAGER
Placitas, NM · On-site
$35.56 - $50.48/hr
Utilization Management *SRMC Care Management *Full Time *Part Time Receive 17% Weekday Nights, 26 ... This is supported by a chart review for the level of care and correcting billing aspects of care ...
RN CASE MANAGER
Placitas, NM · On-site
$35.56 - $50.48/hr
Utilization Management *SRMC Care Management *Full Time *Part Time Receive 17% Weekday Nights, 26 ... This is supported by a chart review for the level of care and correcting billing aspects of care ...
RN CASE MANAGER
Albuquerque, NM · On-site
$35.56 - $50.48/hr
Utilization Management *SRMC Care Management *Full Time *Part Time Receive 17% Weekday Nights, 26 ... This is supported by a chart review for the level of care and correcting billing aspects of care ...
RN CASE MANAGER
Albuquerque, NM · On-site
$35.56 - $50.48/hr
Utilization Management *SRMC Care Management *Full Time *Part Time Receive 17% Weekday Nights, 26 ... This is supported by a chart review for the level of care and correcting billing aspects of care ...
RN CASE MANAGER
Tijeras, NM · On-site
$35.56 - $50.48/hr
Utilization Management *SRMC Care Management *Full Time *Part Time Receive 17% Weekday Nights, 26 ... This is supported by a chart review for the level of care and correcting billing aspects of care ...
RN CASE MANAGER
Tijeras, NM · On-site
$35.56 - $50.48/hr
Utilization Management *SRMC Care Management *Full Time *Part Time Receive 17% Weekday Nights, 26 ... This is supported by a chart review for the level of care and correcting billing aspects of care ...
Remote Triage Nurse
Albuquerque, NM · On-site +1
$80K/yr
... are utilization. Together with our health plan partners, we are changing the way our society ... Such requests will be subject to review and approval by the Company, and exemptions will be granted ...
Remote Triage Nurse
Albuquerque, NM · On-site +1
$80K/yr
... are utilization. Together with our health plan partners, we are changing the way our society ... Such requests will be subject to review and approval by the Company, and exemptions will be granted ...
Nurse (Case Management)
Albuquerque, NM · On-site
Job Title Registered Nurse Duties Manage a caseload of patients with chronic conditions by ... Collects and maintains case management data, including service utilization, identified barriers ...
Nurse (Case Management)
Albuquerque, NM · On-site
Job Title Registered Nurse Duties Manage a caseload of patients with chronic conditions by ... Collects and maintains case management data, including service utilization, identified barriers ...
Travel LPN / LVN - Long-Term Care - $25 per hour in Albuquerque, NM
$25.40 - $29.30/hr
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
Travel LPN / LVN - Long-Term Care - $25 per hour in Albuquerque, NM
$25.40 - $29.30/hr
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... review and revision of plan of care; 3. Provision of Direct Patient Care: 3.1. Administers ... RN, participates in Utilization Management or Interdisciplinary Care Management Meeting to ...
New
... review and revision of plan of care; 3. Provision of Direct Patient Care: 3.1. Administers ... RN, participates in Utilization Management or Interdisciplinary Care Management Meeting to ...
New
Travel LPN
$25 - $34/hr
Participates in review and revision of plan of care; * Provision of Direct Patient Care ... At the direction of the RN, participates in Utilization Management or Interdisciplinary Care ...
New
Travel LPN
$25 - $34/hr
Participates in review and revision of plan of care; * Provision of Direct Patient Care ... At the direction of the RN, participates in Utilization Management or Interdisciplinary Care ...
New
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
... reviews, to craft personalized care plans. * Administer prescribed medications and treatments ... Adhere rigorously to infection control procedures, encompassing proper hand hygiene and utilization ...
Utilization Review Nurse information
See Rio Rancho, NM salary details
$19.30 - $23.20
2% of jobs
$23.20 - $27.10
9% of jobs
$29.77 is the 25th percentile. Wages below this are outliers.
$27.10 - $31
21% of jobs
The median wage is $34.16 / hr.
$31 - $34.91
23% of jobs
$34.91 - $38.81
13% of jobs
$41.84 is the 75th percentile. Wages above this are outliers.
$38.81 - $42.71
10% of jobs
$42.71 - $46.61
8% of jobs
$46.61 - $50.52
5% of jobs
$50.52 - $54.42
5% of jobs
$54.42 - $58.32
2% of jobs
$58.32 - $62.22
2% of jobs
$19
$38
$62
How much do utilization review nurse jobs pay per hour?
What are the key skills and qualifications needed to thrive as a Utilization Review Nurse, and why are they important?
What does a Utilization Review Nurse do?
What are some typical challenges Utilization Review Nurses face when communicating with healthcare providers and insurance companies?
What Does a Utilization Review Nurse Do?
A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.
What is the difference between Utilization Review Nurse vs Case Manager?
| Aspect | 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, insurance companies, community health settings |
| Employer & Industry Usage | Primarily in insurance and healthcare organizations for reviewing medical necessity | In healthcare and insurance for coordinating patient care and discharge planning |
Utilization Review Nurses focus on evaluating the necessity and appropriateness of medical services, often working in insurance or healthcare settings. Case Managers coordinate patient care, discharge planning, and resource management. While both roles require RN licensure and related certifications, their primary responsibilities differ: UR Nurses review medical necessity, whereas Case Managers facilitate patient care and services.
Other
Medical, Dental, Vision, Retirement, PTO
Posted 23 days ago
Encompass Health rating
6.9
Based on 404 frontline employees who took The Breakroom Quiz
452nd of 870 rated healthcare providers
Job description
Case Management Director Career Opportunity
Highly regarded for your Case Management Director expertise
Are you an experienced and compassionate healthcare professional with a background in case management, seeking a career that aligns with your professional expertise and resonates with your personal values? As the Director of Case Management at Encompass Health, you have the unique opportunity to lead a team and make a profound impact on the lives of individuals within your local community. This role combines fulfilling career opportunities close to home with the chance to make a meaningful difference in the well-being of those around you. Join us in this journey of care, compassion, and leadership as we work together to make a difference where it matters most, serving as a key member of our leadership team overseeing the day-to-day operations and management of our Case Management department.
A Glimpse into Our World
At Encompass Health, you'll experience the difference the moment you become a part of our team. Being at Encompass Health means aligning with a rapidly growing national inpatient rehabilitation leader. We take pride in the growth opportunities we offer and how our team unites for the greater good of our patients. Our achievements include being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For Award, among other accolades, which is nothing short of amazing.
Starting Perks and Benefits
At Encompass Health, we are committed to creating a supportive, inclusive, and caring environment where you can thrive. From day one, you will have access to:
Affordable medical, dental, and vision plans for both full-time and part-time employees and their families.
Generous paid time off that accrues over time.
Opportunities for tuition reimbursement and continuing education.
Company-matching 401(k) and employee stock purchase plans.
Flexible spending and health savings accounts.
A vibrant community of individuals passionate about the work they do!
Become the Case Management Director you've always aspired to be
Assume responsibility for the day-to-day operations and human resource management of the Case Management department.
Oversee the interdisciplinary plan of care and the discharge planning process to ensure the effectiveness and appropriateness of services with a central focus on census management, patient care outcomes, and key care indicators.
Act as a patient and family advocate, ensuring that services are delivered to meet the needs of patients and their families.
Provide guidance and support to Case Managers and other staff, including training on managing caseloads and interpreting regulations, policies, operational procedures, and objectives. Review operations to ensure a high level of quality consistent with organizational standards.
Build relationships with insurance companies, self-insured employers, case management firms, and other healthcare networks.
Celebrate the accomplishments and successes of our dedicated employees along the way.
Qualifications
Current CCM or ACMTM certification is preferred.
Must be qualified to independently complete an assessment within the scope of practice of his/her discipline.
If licensure is required for the discipline within the hospital's state, individual must hold an active license.
For Nursing, must possess bachelor's degree in nursing (BSN) with RN licensure.
For other eligible health care professionals, must possess a minimum of a bachelor's degree; a graduate degree is preferred.
Three years of hospital-based Case Management experience, including Utilization Review and Discharge Planning experience.
May be required to work weekdays and/or weekends, evenings and/or night shifts.
May be required to work on religious and/or legal holidays on scheduled days/shifts.
The Encompass Health Way
We proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing!
At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.
We're eager to meet you, and we genuinely mean that. Join us on this remarkable journey!
What Encompass Health employees say
Pay
Benefits
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Workplace
Get the full story on Breakroom
About Encompass Health
Sourced by ZipRecruiter
Helping patients regain hope and independence, Encompass Health is a national leader in post-acute care. We operate rehabilitation hospitals in 36 states as well as Puerto Rico. Following the Encompass Way, we are driven by our core values: We proudly set the standard, lead with empathy, do what's right, focus on the positive, and remain stronger together.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Birmingham, AL, US
Year founded
1984