Utilization Review Nurse-RN Job at Personify Health

Utilization Review Nurse-RN

The Utilization Review Nurse will provide professional assessments and review fo...

Location

United States

Salary:

30.00 - 38.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

Current RN license in the United States or U.S. territory
Associate’s degree or diploma (Nursing program) required
1+ year clinical experience required
Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards
Ability to maintain regular, punctual attendance
Ability to sit for 6-8 hours
Constant use of computer keyboard and mouse
repetitive use of both hands
Occasional to frequent twisting of neck
occasional bending of neck and at waist

Job Responsibility

Provide professional assessment and review for the medical necessity of treatment requests and plans
Provide first level review for all outpatient and ancillary pre-certification requests for medical appropriateness
inpatient hospital stay including mental health, substance abuse, skilled nursing, and rehabilitation for medical necessity
and post claim or post service reviews
Work to the top of the RN license and ensure proper referral to medical director for denial authorizations through independent review organizations (IRO)
Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care
Refer requests that fall outside of established guidelines to advance review or senior care consultants
Process appeals for non-certification of services, complete non-certification letters when appropriate
Review plan document for benefit determinations
attempt to redirect providers and patients to PPO providers

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions
Paid Time Off
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

Fulltime

Case Manager Nurse-RN

We are seeking Case Manager Nurse, RN, to join our team part-time. As a Case Man...

Location

United States

Salary:

36.00 - 38.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

Graduation from an accredited Registered Nursing (RN) program
Possession of a current California RN license
a multi-state license will also be required
Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience
Prior case management experience, emergency room, critical care background or other relevant clinical care experience pertinent to case management
Knowledge of medical claims and ICD-10, CPT, HCPCS coding
Ability to critically evaluate claims data and determine treatment plan, discharge planning experience
Ability to work independently making decisions and problem solving
Knowledge of community resources and alternate funding programs
Computer proficiency or working knowledge of Microsoft Office Suite

Job Responsibility

Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs
Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals
Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner
report measurable outcomes that record effectiveness of interventions
Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care
Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs
provide patient/family with emotional support and guidance
Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis
Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports

What we offer

Part-time schedule designed around your availability and life priorities
Access to learning and development opportunities alongside full-time colleagues
Mentorship and skill-building that translates to career advancement
Competitive hourly compensation that values your expertise
Technology and equipment support to set you up for success

Parttime

Case Manager Nurse-RN

We are seeking Case Manager Nurse, RN, to join our team part-time. As a Case Man...

Location

United States

Salary:

36.00 - 38.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

Graduation from an accredited Registered Nursing (RN) program
Possession of a current California RN license
a multi-state license will also be required
Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience
Prior case management experience, emergency room, critical care background or other relevant clinical care experience pertinent to case management
Knowledge of medical claims and ICD-10, CPT, HCPCS coding
Ability to critically evaluate claims data and determine treatment plan, discharge planning experience
Ability to work independently making decisions and problem solving
Knowledge of community resources and alternate funding programs
Computer proficiency or working knowledge of Microsoft Office Suite

Job Responsibility

Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs
Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals
Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner
report measurable outcomes that record effectiveness of interventions
Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care
Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs
provide patient/family with emotional support and guidance
Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis
Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports

What we offer

Part-time schedule designed around your availability and life priorities
Access to learning and development opportunities alongside full-time colleagues
Mentorship and skill-building that translates to career advancement
Competitive hourly compensation that values your expertise
Technology and equipment support to set you up for success

Parttime

Case Manager Nurse-RN

As a Case Manager RN, you will provide telephonic case management between provid...

Location

United States

Salary:

36.00 - 38.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

Graduation from an accredited Registered Nursing (RN) program
Possession of a current California RN license
a multi-state license will also be required
Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience
Prior case management experience, emergency room, critical care background or other relevant clinical care experience pertinent to case management
Knowledge of medical claims and ICD-10, CPT, HCPCS coding
Ability to critically evaluate claims data and determine treatment plan, discharge planning experience
Ability to work independently making decisions and problem solving
Knowledge of community resources and alternate funding programs
Computer proficiency or working knowledge of Microsoft Office Suite

Job Responsibility

Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs
Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals
Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner
report measurable outcomes that record effectiveness of interventions
Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care
Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs
provide patient/family with emotional support and guidance
Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis
Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions
Paid Time Off
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

Fulltime

Resident Assistant

If you’re looking for a job that goes beyond the basics to deliver purpose and j...

Location

United States of America , Hillsboro

Salary:

18.00 - 20.00 USD / Hour

Leisure Care

Expiration Date

Until further notice

Requirements

Demonstrated experience in a caregiving role
Current CNA a plus!

Job Responsibility

Assists resident with activities of daily living (ADL's) and all personal care skills (bathing, dressing, grooming, toileting)
Makes appropriate observations about the resident’s condition in every interaction
Records and follows-up with changes in resident’s condition in a timely manner
Assists residents with laundry and housekeeping services as needed

What we offer

Medical, Dental and Vision
Early Wage Access (access to earned wages when needed!)
401k
10 days vacation & 1 hour Sick Leave earned for every 30 hours worked
Bereavement & Jury Duty Leave
6 Holidays
2 Float Holidays
Flexible Spending Accounts (Health and Dependent Care)
Meal Discounts
Tuition Assistance

Fulltime

Traffic Management CAD Technician

FM Conway is currently recruiting a Traffic Management CAD Technician to join ou...

Location

United Kingdom , Ipswich

Salary:

Not provided

360 Resourcing Solutions

Expiration Date

July 04, 2026

Requirements

Strong knowledge of Traffic Management operations
experience using CAD, BricsCAD and Cone 11 software
ability to read and translate blueprints and technical drawings
ability to work well under pressure, prioritise tasks effectively and have excellent attention to detail
M7 Lantra qualification is highly desirable, but not essential

Job Responsibility

Working within a team of Traffic Management development designers and Project Engineers to ensure that drawings are to a high and legal standard
Producing clear drawings, signage placement layouts and diversion route strategies
Developing safe and efficient traffic management plans for work sites and road network
Carrying out on site assessments as required
Designing sites in accordance with Chapter 8 TSM
Engaging with Project Teams & Engineers to respond effectively to working methods that require traffic Management designs that conform to a legal standard

What we offer

Career and professional development
23 days holiday plus bank holidays
Life assurance
Opportunities for internal and external training
Access to a wide range of shopping discounts through Rewarding Great People platform
Health and well-being benefits including 24-hour advice lines
Support from in-house mental health first aiders

Fulltime

Registered Nurse, CVOR

Baptist Downtown is hiring a Registered Nurse for our Cardiovascular Operating R...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

1-2 years Operating Room Nursing Experience Required
Basic Life Support (BLS) Required
Advanced Cardiac Life Support (ACLS) Required
Licensed Registered Nurse Required
Associate of Science, Nursing
Registered Nurse (RN) - State Nursing Boards
Driver's License - DMV
Basic Life Support (BLS) - AHA
Advanced Cardiac Life Support (ACLS) - AHA

Job Responsibility

Providing for patient needs as recognized through use of the nursing process
Supervision of care provided by supportive personnel and coordination of care provided by ancillary services
Including patients and significant others (SO)/families in developing an individualized plan of care
Education of patients/SO/families to their disease process and plan of care
Coordinating and preparing assigned operating room/case
Assessment of patient care needs and the anticipation of needs of the case
Circulating, scrubbing, assisting on Cardiothoracic and vascular procedures

Fulltime

Pediatric Occupational Therapist

Wolfson Children's Hospital Rehab Services is hiring a Pediatric Occupational Th...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

Bachelor's degree (or higher) in Occupational Therapy Required
Licensed Occupational Therapist from FL Department of Health Required
Basic Life Support (BLS) certification from the American Heart Association Required
Pediatric Occupational Therapy in the outpatient setting is strongly preferred

Job Responsibility

Evaluates and treats patients with developmental, neurological, orthopedic, and medical diagnoses
Extensive patient/family education
Works with multidisciplinary team care

What we offer

$1,000 Sign on Bonus

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Utilization Review Nurse-RN

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What we offer

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