The Registered Nurse (RN) - Utilization Review monitors patient charts and records to evaluate care concurrent with the patients treatment. Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Being a Registered Nurse (RN) - Utilization Review collects and complies data as required and according to applicable policies and regulations. Reviews treatment plans and status of approvals from insurers. In addition, Registered Nurse (RN) - Utilization Review consults with physicians as needed. May require a bachelor's degree. Typically reports ... view job details

Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). Contributes to moderately complex aspects of a project. Work is generally independent and collab... view job details

Performs each review process following the appropriate policy & procedure and within standard time frames. Maintains reports relating to the implementation, coordination, and follow-up of medical management review processes and special projects. Interacts with Data Management and appropriate Supervisor to provide system maintenance to the Referral and Case Management applications. view job details

Conduct remote utilization reviews of medical records to determine the appropriateness and necessity of healthcare services. Provide education and support to healthcare providers and staff regarding utilization review processes and requirements. Communicate with healthcare providers to gather additional information and clarify documentation related to patient care. view job details

The Care and Utilization Review Nurse Manager oversees staff that process referrals, authorizations, billing, utilization review, and capitation for hospital services. Supervises and coordinates activities of personnel in the managed care operations department of a healthcare facility. Being a Care and Utilization Review Nurse Manager requires a bachelor's degree. Experienced in utilization review techniques and protocols. In addition, Care and Utilization Review Nurse Manager typically reports to a manager or head of a unit/department. May require Registered Nurse (RN). Makes day-to-day decis... view job details

The Care and Utilization Review Nurse Coordinator ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Coordinates utilization reviews of managed care contracts using established guidelines and processes. Being a Care and Utilization Review Nurse Coordinator maintains managed care contracts and information databases and prepares reports. Communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. In addition, Care and Utilization Review Nurse Coord... view job details

Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). Gains exposure to some of t... view job details

The Utilization Review Specialist monitors patient charts and records to evaluate care concurrent with the patients treatment. Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Being a Utilization Review Specialist collects and complies data as required and according to applicable policies and regulations. Reviews treatment plans and status of approvals from insurers. In addition, Utilization Review Specialist consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Reg... view job details

Meet with Utilization Review and other healthcare team members to discuss selected cases and make recommendations regarding patient status. Performs regular, follow-up and focused chart audits/reviews (concurrent and retrospective) for the purpose of assessing the accuracy of clinical documentation and utilization. Works in collaboration with the Medical Director of Centralized UR/HIM, utilization committees and medical staff to maintain and improve utilization and documentation efforts. view job details

Utilize clinical information and knowledge of Behavioral Health Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and health care partners. Collaborate in Continuing Care planning to ensure timely discharge, optimal benefit, and financial utilization, as well as compliance with industry discharge standards. Supervise all UR staff and assist with difficult cases. view job details

Assist in the development and implementation of utilization review policies and procedures. Maintain accurate and detailed records of utilization review activities and decisions. Communicate with healthcare providers to gather additional information and documentation as needed. view job details

There is currently no job description for Rn Utilization Review. Be the first to submit the job responsibilities for a Rn Utilization Review.

There is currently no job description for Utilization Review Manager. Be the first to submit the job responsibilities for a Utilization Review Manager.