Remote utilization review nurse jobs may


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WATCH RELATED VIDEO: Utilization Review Nurse - Work from home!

Utilization Review LVN RN


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Company: Inland Empire Health Plans. Responsible for reviewing prospective, concurrent, and retrospective reviews for medical necessity and appropriateness of service and care including specialist, outpatient and ancillary services, , outpatient surgery, durable medical equipment, home health, and any high dollar cases.

Responsible for the prospective and retrospective review of referral denials, denial letters, and logs to determine appropriateness of denial, possible alternative treatment, and evaluation for case management or quality of care issues in collaboration and direction of UM Medical Director. Draft denial language to ensure consistent application of standardized, nationally recognized UM criteria and appropriate use of denial language. Create and maintain a standardized matrix of denial language split by LOB for internal and external use.

Responsible for assisting with the letter of agreement process when referring Members to out-o-network providers. Review and report quality review findings with UM Management in order to support requirements of accuracy and productivity on a monthly basis. Screen medical information provided and authorization requests for medical necessity and appropriateness, comparing the information to current criteria and discussing with Medical Directors.

Assist Medical Directors with benefit interpretation, obtaining additional medical necessity information and researching issues. Attend staff meetings and education trainings necessary to maintain current nursing and UM knowledge. Assist with the utilization management section of the Medical Management audit, as well as focused referral and denial audits. Two 2 or more years of utilization management experience in a health care delivery setting specifically in prior authorization or two 2 or more years of experience in an acute care facility.

Exhibits a high attention to detail in documenting UM referral reviews. Ability to work at a high level of speed while maintaining accuracy. Ability to work well with both physician and nursing staff. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Word processing involving computer keyboard and screens, and automobile travel within the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6, and a team of more than 2, employees, IEHP provides quality, accessible healthcare services to more than 1. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace.

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However, blocking some types of cookies may impact your experience of the site and the services we are able to offer. Search by job keyword. View Profile. Create Alert. Share this Job. Major Functions Duties and Responsibilities. Experience Qualifications. Preferred Experience. Education Qualifications. High school diploma or GED required. Professional Licenses. Drivers License Required. Knowledge Requirement. Abilities Requirement. Commitment to Team Culture.

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Taking a Closer Look at the (Relatively) Least Stressful Nursing Jobs

Utilization Management UM is the process of ensuring that health care services are performed in a cost-efficient and guideline-compliant nature. Utilization Management Nurses play an important role in containing healthcare costs by reviewing rendered services against standardized guidelines to ensure appropriate utilization of resources. To dive a bit deeper, I conducted a poll of 26 Utilization Management Nurses and found some interesting stats:. Thank you to all the nurses who responded! Are you interested in becoming a Utilization Management Nurse? Visit my UM Job Page to explore options now! Remote Nurse Spotlight:.

Clinical Administrative Coordinator - Remote - Saint Paul, MN. 12/07/ Medical & Clinical Operations. Nurse.

Remote nursing jobs: working from home as an RN.

Overview Using Payscale recently released research on the State of Remote Work in Bonuses are a beautiful thing. A base salary, also known as base pay, is the initial compensation If we learned anything from , is that the polls don't. The primary responsibility of the utilization review nurse is to review medical records and prepare clinical appeals when appropriate on medical necessity, level of care, length of stay, and authorization denials for hospitalized patients. An understanding of the severity of an array illnesses, intensity of service, and care coordination needs are key, as the nurse must integrate clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care …Read more. Software Streamlined solutions for every step of the compensation management journey.


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remote utilization review nurse jobs may

Essential to this role are the core values of patient advocacy, holistic assessment, care planning, and the empowerment of patients and families to self Public Notice — Effective January 1, through June 30, , your SNAP Supplemental Nutrition Assistance Program, formerly Food Stamps benefits may be changing. Interested in making a difference in the life of a child? Do you have empathy for families going through hardship? Demonstrate that there are not enough U. Workers can work at home and make money by choosing from thousands of … 4.

Non-Kuwaiti applicants, also, obtain residence in work location. Emergency Medicine Consultant or Specialist.

HEDIS Abstraction: A Seasonal Remote Gig for Nurses

View fidelis care Salary. You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. Position Purpose: The Utilization Review Nurse I provides first level clinical review for all outpatient and ancillary services requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a professional and competent manner.


79 Utilization Review Nurse Jobs in Philadelphia,Pa

There are over 43, insurance company nurse careers waiting for you to apply! Job Description Simplyhired. Legal consulting is a great way to explore non-bedside nursing and take your professional experience to the courtroom. Join Farmers Insurance Talent Community. Because we believe that how we treat one another is just as important as what we deliver to our customers. For years, MetLife has operated as a good corporate citizen. Throughout our six major campuses and hundreds of claims offices across the country, you'll find a diverse group of more than 40, talented employees. Start: ASAP.

There are plenty of nursing careers that can be done remotely - including in a clinical setting before taking on this home nursing job.

10 Common Remote Nursing Jobs from Home

The U. Food and Drug Administration has released a draft of new guidance focused on using digital health technologies to acquire data remotely from participants in clinical investigations of medical products. At the same time, it said, sponsors and stakeholders should ensure their technology of choice is fit for its intended purpose. The FDA notes that digital health tools used for remote data acquisition can offer an important role in clinical research.


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Apr 9, Blog , Career Advice. Nurses working in busy clinical arenas often hear about nurses who have left the floor to work in administrative departments. Utilization review is one of the least understood but incredibly essential departments in managing the cost of health care. Experienced nurses can bring a valuable perspective to this field.

As technology has advanced, more people than ever before are looking for ways to be able to work at home.

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Share Job. Suggest Revision. Job Description Actalent is looking for a remote Utilization Nurse Job Duties: Review cases of members on a daily basis to deem if they are qualified for insurance coverage. Compensation is tied to the Colorado market for jobs performed in Colorado. Other locations may be subject to variances based on locations-related factors.

Thanks for such great info! Is there a certification course or something to make sure this is for me? Have a great day! Hi there!


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