Utilization Review Nurse jobs in Providence, RI

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Director-Clin Admissions LVN
Prior experience in utilization review or discharge planning preferred.7. Triage clinical cases in Yellow or NonStandard criteria to appropriate Area designee,...
Senior Nurse Director of Case Management
Clinical Management Consultants - Worcester, MA
$120,848 - $168,897 a year
This is a very large role over case management, utilization review, social workers, and centralized appeals and denials....
Mobil RN Care Partner
Participates in utilization and case review as necessary. Manages panel-wide and member-specific utilization trends....

Clinical Management Nurse

Neighborhood Health Plan of Rhode Island - 12 reviews - Smithfield, RI
Utilization review or case management certification. Medical/Utilization review experience. Documents cost savings that may result from medical review process...

Utilization Care Manager

Lifespan - 132 reviews - Providence, RI 02903 (Downtown area)
Has a high level of knowledge concerning utilization review, healthcare finance and the requirements of relevant payers....

Clinical Documentation Specialist

Lifespan - 132 reviews - Providence, RI 02903 (Downtown area)
Familiarity with utilization review, case management, nurse review activities or coding experience preferred....

Case Manager - Integrated Behavioral Health

CharterCARE Health Partners - 11 reviews - North Providence, RI
In addition to the skills normally obtained through completion of a High School education, must be a Registered Nurse, BSN preferred....

Nurse Care Mgr, Triage

Senior Whole Health LLC - 2 reviews - Bridgewater, MA 02324
In addition to managing a caseload of community members, the Triage Nurse will review all SWH applications and perform initial assessments on appropriate new...

Nurse Care Mgr, UM

Senior Whole Health LLC - 2 reviews - Bridgewater, MA 02324
The SWH Utilization Management nurse is responsible for performing concurrent and retrospective utilization review and facilitating discharge planning....

Nurse Educator

Steward Health Care - 55 reviews - Fall River, MA
Experience in quality management and utilization review preferred. Audits clinical records for appropriate utilization of services, quality outcome measurement,...

Nurse Care Mgr, Community

Senior Whole Health LLC - 2 reviews - Bridgewater, MA 02324
Provides utilization management and issuance of appropriate authorizations for covered services. Prepare for and participate in clinical case reviews to share...

Nurse Care Mgr. Per Diem

Senior Whole Health LLC - 2 reviews - Bridgewater, MA 02324
Nurse Care Manager, Community. Provides utilization management and issuance of appropriate authorizations for covered services....

ED Care Navigator

CharterCare Health Partners - Providence, RI
Registered Nurse or Case Management in ED:. Experience in ED as a registered nurse or case manager preferred....
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Licensed Practical Nurse (LPN)
Next Step Health Care - 4 reviews - Attleboro, MA 02703
Licensed Practical Nurse (LPN). Nurse Supervisor/Unit Manager, DNS, ADNS. Participates in review and revision of plan of care....
Manager, UM Clinical Services - FALLON HEALTH - Growing Heal...
Fallon Health - 66 reviews - Worcester, MA
Creates reports to monitor inpatient utilization (UM Nurse) productivity and performance. 2 years’ experience as a Utilization Management nurse in a managed...