San Juan, PR · On-site
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
San Juan, PR · On-site
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
San Juan, PR · On-site
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
San Juan, PR · On-site
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
$17 - $21.75/hr
Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...
$17 - $21.75/hr
Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...
Manati, PR · On-site
$17 - $21.75/hr
Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...
Manati, PR · On-site
$17 - $21.75/hr
Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...
PR · On-site
Provide backup to Utilization Review Department out of business hours including document in the ... Valid and current active license for Social Work, Psychiatric Nursing, Psychological Counseling ...
San Juan, PR · On-site
$57 - $68.75/hr
... Utilization Review program protocols providing clinical recommendations pertaining to, but not ... Extended hours and occasional weekends may be required as needed Preferred Qualifications: * 1 ...
San Juan, PR · On-site
$57 - $68.75/hr
... Utilization Review program protocols providing clinical recommendations pertaining to, but not ... Extended hours and occasional weekends may be required as needed Preferred Qualifications: * 1 ...
Guaynabo, PR · On-site
Fax intake and labeling on weekends/Holidays as needed About You * Bachelor's Degree or relevant ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...
Guaynabo, PR · On-site
Fax intake and labeling on weekends/Holidays as needed About You * Bachelor's Degree or relevant ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...
Guaynabo, PR · On-site +1
Fax intake and labeling on weekends/Holidays as needed About You * Bachelor's Degree or relevant ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...
Guaynabo, PR · On-site +1
Fax intake and labeling on weekends/Holidays as needed About You * Bachelor's Degree or relevant ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...
San Juan, PR · On-site
$21 - $26.75/hr
Participate in interdisciplinary team huddles, case reviews, and care planning meetings. * Maintain ... utilization. * Build trusting relationships with patients and caregivers while promoting patient ...
San Juan, PR · On-site
$21 - $26.75/hr
Participate in interdisciplinary team huddles, case reviews, and care planning meetings. * Maintain ... utilization. * Build trusting relationships with patients and caregivers while promoting patient ...
San Juan, PR · On-site
$21 - $26.75/hr
Participate in interdisciplinary team huddles, case reviews, and care planning meetings. * Maintain ... utilization. * Build trusting relationships with patients and caregivers while promoting patient ...
San Juan, PR · On-site
$21 - $26.75/hr
Participate in interdisciplinary team huddles, case reviews, and care planning meetings. * Maintain ... utilization. * Build trusting relationships with patients and caregivers while promoting patient ...
San Juan, PR · On-site
Additional hours, including weekends or holidays, may be required based on operational needs. The ... Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of ...
San Juan, PR · On-site
Additional hours, including weekends or holidays, may be required based on operational needs. The ... Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of ...
Additional hours, including weekends or holidays, may be required based on operational needs. The ... Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of ...
Additional hours, including weekends or holidays, may be required based on operational needs. The ... Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of ...
... reviews of Service Member health and dental records, interpret clinical findings (e.g., labs ... weekend work to support readiness events. • U.S. citizenship and ability to pass background ...
... reviews of Service Member health and dental records, interpret clinical findings (e.g., labs ... weekend work to support readiness events. • U.S. citizenship and ability to pass background ...
Additional hours, including weekends or holidays, may be required based on operational needs. The ... Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of ...
Additional hours, including weekends or holidays, may be required based on operational needs. The ... Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of ...
$78K - $106K/yr
Provide leadership support during significant safety events or regulatory reviews * Ensure ... Availability for evening and weekend work as needed * On-site presence in facilities 2-3 days per ...
$78K - $106K/yr
Provide leadership support during significant safety events or regulatory reviews * Ensure ... Availability for evening and weekend work as needed * On-site presence in facilities 2-3 days per ...
PR · On-site
Investigate and resolve discrepancies related to utilization, eligibility, or payment amounts ... Compile documentation requested during internal or external reviews * Ensure outputs align with ...
Quick apply
$13.75 - $18.75/hr
Ability to work a flexible work schedule, including nights, weekends, and holidays is required ... When we do have an open position, we will review your application to determine if your ...
$13.75 - $18.75/hr
Ability to work a flexible work schedule, including nights, weekends, and holidays is required ... When we do have an open position, we will review your application to determine if your ...
$13.75 - $18.75/hr
Ability to work a flexible work schedule, including nights, weekends, and holidays is required ... When we do have an open position, we will review your application to determine if your ...
$13.75 - $18.75/hr
Ability to work a flexible work schedule, including nights, weekends, and holidays is required ... When we do have an open position, we will review your application to determine if your ...
$41K - $78K/yr
... utilization, and clinical excellence. Educate physicians, fellows, nurses, and staff through ... be reviewed at www.bscbenefitsconnect.com. Actual compensation will be commensurate with ...
$41K - $78K/yr
... utilization, and clinical excellence. Educate physicians, fellows, nurses, and staff through ... be reviewed at www.bscbenefitsconnect.com. Actual compensation will be commensurate with ...
$9 - $12.25/hr
Ability to work a flexible work schedule, including nights, weekends, and holidays is required ... When we do have an open position, we will review your application to determine if your ...
$9 - $12.25/hr
Ability to work a flexible work schedule, including nights, weekends, and holidays is required ... When we do have an open position, we will review your application to determine if your ...
| Aspect | Weekend Cigna Utilization Review Nurse |
|---|
Weekend Cigna Utilization Review Nurses primarily evaluate medical cases for insurance coverage, focusing on utilization review. In contrast, Weekend Case Managers coordinate patient care, discharge planning, and resource management. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ—review vs. care coordination.
Full-time
Re-posted 21 days ago
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
ResponsibilitiesESSENTIAL FUNCTIONS:
OTHER FUNCTIONS:
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
LICENSES/DESIGNATIONS/CERTIFICATIONS:
ADDITIONAL REGULATORY REQUIREMENTS:
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.
Employment Type: FULL_TIME
