Clinical Utilization Review Nurse
3 weeks ago
At ClickJobs, we are seeking a highly skilled Clinical Utilization Review Nurse to join our team. As a key member of our Utilization Review team, you will play a critical role in ensuring that our members receive the highest quality care while minimizing unnecessary costs.
Key Responsibilities:- Coordinate and review medical records to assess whether the criteria for admission and continuation of treatment is being met.
- Participate in Case Management and Treatment Team meetings to ensure seamless communication and coordination of care.
- Provide education to all departments on utilization review best practices and guidelines.
- Review patient charts to identify opportunities for cost savings and quality improvement.
- Communicate with fiscal intermediaries, patients, and families to ensure timely and accurate referral determinations.
- Identify referrals for review by the medical director and ensure proper coding and documentation.
- Work closely with the supervisor/lead to address issues and delays that can impact compliance.
- Meet or exceed production and quality metrics.
- CA LVN license required; CA RN license preferred.
- Bachelor's or Master's degree in Social Work, behavioral or mental health, nursing, or other related health field preferred.
- 3 to 5 years of acute care experience preferred.
- 2 years of managed care experience in UM/CM Department preferred.
- Knowledge of CMS, State Regulations, URAC, and NCQA guidelines.
- ICD-9 and CPT coding experience a plus.
- Experience working with Microsoft Word, Outlook, Excel, and health plan medical management documentation systems a plus.
- Experience with EZ-CAP preferred.
- Medical Terminology preferred.
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Clinical Utilization Review Nurse
4 weeks ago
Dubai, Dubai, United Arab Emirates ClickJobs Full timeJob Title: Clinical Utilization Review NurseAt ClickJobs, we are seeking a highly skilled Clinical Utilization Review Nurse to join our team. As a key member of our Utilization Review Department, you will play a critical role in ensuring the quality and efficiency of our healthcare services.Key Responsibilities:Coordinate and review medical records to assess...
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Clinical Utilization Review Nurse
4 weeks ago
Dubai, Dubai, United Arab Emirates ClickJobs Full timeJob Title: Clinical Utilization Review NurseAt ClickJobs, we are seeking a highly skilled Clinical Utilization Review Nurse to join our team. As a key member of our Utilization Review team, you will play a critical role in ensuring that our members receive the highest quality care while minimizing unnecessary costs.Key Responsibilities:Coordinate and review...
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Clinical Review Nurse Specialist
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Dubai, Dubai, United Arab Emirates Actalent Full timeJob Title: Clinical Review NurseActalent is seeking a skilled Clinical Review Nurse to join our team in a fully remote role. As a Clinical Review Nurse, you will be primarily responsible for conducting utilization reviews and concurrent reviews of post-acute care.Key Responsibilities:Conduct thorough utilization reviews to ensure the appropriateness of...
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Clinical Review Nurse Specialist
4 weeks ago
Dubai, Dubai, United Arab Emirates Actalent Full timeJob Title: Clinical Review NurseActalent is seeking a skilled Clinical Review Nurse to join our team in a fully remote role. As a key member of our team, you will be responsible for conducting utilization reviews and concurrent reviews of post-acute care.Key Responsibilities:Conduct thorough utilization reviews to ensure quality care and optimal resource...
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Clinical Review Nurse Specialist
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Dubai, Dubai, United Arab Emirates Actalent Full timeJob SummaryWe are seeking a skilled Clinical Review Nurse to join our team at Actalent. As a Clinical Review Nurse, you will be responsible for conducting utilization reviews and concurrent reviews of post-acute care. This is a fully remote role that requires a compact RN license and a minimum of 5 years of nursing experience, including 1-2 years of acute...
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Clinical Review Nurse Specialist
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Dubai, Dubai, United Arab Emirates Actalent Full timeClinical Review Nurse OpportunityActalent is seeking a skilled Clinical Review Nurse to join our team in a fully remote role. As a Clinical Review Nurse, you will be responsible for conducting Utilization Review and Concurrent Review of post-acute care.Key Responsibilities:Conduct thorough reviews of patient records to ensure medical necessity and...
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Dubai, Dubai, United Arab Emirates Health eCareers Full timeJob SummaryWe are seeking a skilled Continuing Care Utilization Review Coordinator RN to join our team. As a key member of our healthcare team, you will be responsible for conducting utilization reviews for in-house patients and/or those members at contracted facilities. Your expertise will be essential in assisting with discharge planning and ensuring the...
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Dubai, Dubai, United Arab Emirates Health eCareers Full timeJob SummaryWe are seeking a skilled Continuing Care Utilization Review Coordinator RN to join our team. As a key member of our healthcare team, you will be responsible for conducting utilization reviews for in-house patients and/or those members at contracted facilities. Your expertise will be essential in assisting with discharge planning and ensuring that...
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Dubai, Dubai, United Arab Emirates Health eCareers Full timeJob SummaryAs a Continuing Care Utilization Review Coordinator RN at Health eCareers, you will play a vital role in conducting utilization reviews for in-house patients and contracted facilities. Your expertise will assist in the discharge planning process, ensuring seamless transitions for our patients.Key ResponsibilitiesConduct thorough utilization...
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Dubai, Dubai, United Arab Emirates Health eCareers Full timeJob SummaryWe are seeking a skilled Continuing Care Utilization Review Coordinator RN to join our team. As a key member of our healthcare team, you will be responsible for conducting utilization reviews for in-house patients and/or those members at contracted facilities. Your expertise will be essential in assisting with discharge planning and ensuring that...
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Clinical Review Specialist
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