Clinical Utilization Review Nurse
4 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 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 patient eligibility for treatment and services.
- Participate in Case Management and Treatment Team meetings to ensure effective care coordination.
- Provide education and training to healthcare professionals on utilization review best practices.
- Review patient charts to identify areas for improvement and develop strategies for optimizing care.
- Communicate with healthcare providers, patients, and families to ensure timely and accurate referral determinations.
- Identify opportunities for clinical program development and refer members to appropriate healthcare programs.
- Maintain confidentiality and adhere to regulatory guidelines and company policies.
- 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.
- 3-5 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.
- Proficiency in Microsoft Word, Outlook, Excel, and experience working in a health plan medical management documentation system a plus.
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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 Utilization Review Nurse
3 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
3 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 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
4 days ago
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
1 month ago
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
1 month ago
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Clinical Review Specialist
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Dubai, Dubai, United Arab Emirates Actalent Full timeAbout the RoleWe are seeking a skilled Clinical Review Specialist to join our team at Actalent. As a Clinical Review Specialist, you will play a critical role in ensuring the quality and accuracy of healthcare services.Key ResponsibilitiesUtilize clinical judgment to review and analyze healthcare servicesDevelop and implement effective communication...
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Clinical Review Specialist
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Dubai, Dubai, United Arab Emirates ClickJobs Full timeJob SummaryWe are seeking a highly skilled and detail-oriented Clinical Review Specialist to join our team at ClickJobs. As a key member of our healthcare team, you will be responsible for reviewing medical results, providing phone coverage, and ensuring the quality of our services.Key ResponsibilitiesMedical Results Review: Review and verify medical results...
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Clinical Review Specialist
3 weeks ago
Dubai, Dubai, United Arab Emirates ClickJobs Full timeJob SummaryWe are seeking a highly skilled and detail-oriented Clinical Review Specialist to join our team at ClickJobs. As a key member of our healthcare team, you will be responsible for reviewing medical results, providing phone coverage, and ensuring the quality of our services.Key ResponsibilitiesMedical Results Review: Review and verify medical results...
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Male Nurse Specialist
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Nurse Specialist
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Dubai, Dubai, United Arab Emirates European Nurse Recruitment Full timeJob SummaryEuropean Nurse Recruitment is seeking a skilled Nurse Specialist to join our team in a specialized orthopaedic and sports medicine hospital in Qatar. The ideal candidate will have expertise in sports medicine rehabilitation and clinical support, with a focus on treating sports injuries and providing postsurgical care.Key Responsibilities• Manage...
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Dubai, Dubai, United Arab Emirates European Nurse Recruitment Full timeJob OpportunityEuropean Nurse Recruitment is seeking a skilled Nurse to join our team at a specialized orthopaedic and sports medicine hospital in Qatar. The ideal candidate will have expertise in sports medicine rehabilitation and clinical support, with a focus on treating sports injuries and providing postsurgical care.Key Responsibilities• Manage...