AMN Healthcare Revenue Cycle is seeking a travel nurse RN Case Manager, Manager for a travel nursing job in San Diego, California. Job Description & Requirements Specialty: Manager Discipline: RN Start Date: 10/19/2026 Duration: 13 w...

Description Care Manager MSW at Providence Healdsburg Hospital in Healdsburg, CA. This position is Per Diem and will work 8-hour, Day shifts. Providence Healdsburg Hospital is committed to delivering top-notch healthcare, earning recogn...

American Traveler is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Fort Myers, Florida. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 10/26/2026 Durat...

Uniti Med is seeking a travel Home Health Utilization Review for a travel job in Webster, New York. Job Description & Requirements Specialty: Utilization Review Discipline: Therapy Start Date: 10/26/2026 Duration: 13 weeks 40 hours ...

are completed thoroughly and on a timely basis. Interface with managed care organizations, external reviews, and other payers.... Communicate with physicians to schedule peer to peer reviews. Accurately report denials. Qualifications and requirements...

How you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays... and on a timely basis. Interface with managed care organizations, external reviews, and other payers. Communicate with physicians...

required for highly-complex and/or escalated reviews, and providing expert guidance to team members and partnering with the health care... and/or escalated reviews, and providing expert guidance to team members and partnering with the health care team, members...

How you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays... organizations, external reviews, and other payers. Communicate with physicians to schedule peer to peer reviews. Accurately report...

Responsibilities The Valley Health System has expanded into an integrated health network that serves more than two million people in Southern Nevada. Starting with in 1979, the Valley Health System has grown to include , , , Benefit Hig...

appraisals, prepares appraisal reviews and internal scorecards, and helps ensure appraisal activities are executed in alignment... with appraisal engagements and reviews. Conduct market research and provide analytical support to strengthen appraisal review...

. Documentation and Reporting: Document findings from utilization reviews in the appropriate systems and ensure accurate record...

Description: Job Profile Summary: Routinely reviews prior authorization requests to determine medical necessity of service and appropriate... Nurse/ LPN - Licensed Practical Nurse - State Licensure required Performs medical necessity and clinical reviews...

coverage. Conduct clinical reviews of more complex authorization requests and identify any issues or risks. Provide clear...

Responsibilities Coordinates and completes the clinical reviews for all patient medical records while working closely...

shifts*** General Summary of Position Conducts admission concurrent and retrospective case reviews to ensure appropriate... and Responsibilities Conducts admission concurrent and retrospective case reviews to meet hospital objectives of high-quality patient...

and implements care management review processes (Prior Authorization, Predetermination, Concurrent Reviews, Retrospective Reviews... reviews according to accepted and established criteria, as well as other clinical guidelines and policies. 3. Ensures...

needs. Collects quality improvement data in accordance with approved indicators. Monitors and audits staff UM reviews... in multidisciplinary quality and service improvement teams. Performs admission reviews and subsequent concurrent reviews to determine the...

records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, Cigna... and medical chart reviews and proficiency with ICD-10-CM coding guidelines and conventions Familiarity with CMS regulations...

Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the... preferred. Will support Medicaid inpatient concurrent review. Performs concurrent reviews of member for appropriate care...

records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, Cigna... and medical chart reviews and proficiency with ICD-10-CM coding guidelines and conventions Familiarity with CMS regulations...