Utilization Review Nurse (RN)
Evry Health
Position Summary: The RN Integrated Care Coordinator (UM) provides comprehensive care coordination services and is responsible for quality outcomes for members across the care continuum using a variety of data sources. This role is critical to the operation of our Clinical Team and the overall experience of Evry Health’s members.
The incumbent strives to ensure a positive member experience and builds solid relationships with members, providers, and facilities to ensure Evry Health is a reliable and trusted parter in member care. Rotating weekend hours are required to address utilization review cases.
$35 - $45 per hour
...Position: RN / Utilization Review Nurse Location: Sacramento, CA (ON-SITE) Employment Type: Potential contract to hire Pay Range: $35.00 – $45.00/hour (Paid Weekly) Schedule: Monday – Friday, Standard Business Hours Position Summary We are seeking an experienced Utilization...SuggestedWeekly payContract workWork at officeRemote workMonday to Friday- ...Position Summary: The RN Integrated Care Coordinator (UM) provides comprehensive care... ...weekend hours are required to address utilization review cases. Roles and Responsibilities Prepares... ...Must have a current, unrestricted Texas nursing license or Compact License. Please...SuggestedLive inRemote workFlexible hoursWeekday work
- ...To support a mission-driven health organization, the full-time Utilization Review Nurse - RN will conduct medical necessity reviews, escalate non-certifications for secondary clinical review, and analyze clinical records to ensure timely and compliant care determinations...SuggestedFull timeRemote work
$40.12 - $62.19 per hour
...Sinai Hospital's Utilization Review operates as a distinct specialty service line of physician advisors, nurses, and support staff who ensure hospital stays are clinically appropriate... ...: The Utilization Review RN reviews the medical record by applying utilization...SuggestedFull timeRemote work- ...TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews,...SuggestedRemote work
- ...Centene Management Company LLC is hiring for a remote RN/LPN utilization reviewer. You will evaluate patient care, determine appropriate level of care, and contribute to discharge planning while coordinating with Medical Affairs. Role requires 2+ years acute care and UM...Remote workMonday to Friday
$30 - $34 per hour
...A healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active LVN license in California and have experience in outpatient utilization management. Responsibilities include approving or denying...Hourly payRemote work$41 - $45.5 per hour
...Direct Government Clients Role: Nurse Case Management Senior Analyst... ...: Active, unrestricted RN License Must have MCG/InterQual... ...assessments, health education, and utilization management. Key... ...concurrent, and retrospective reviews for inpatient, rehab, referrals...Remote work- ...Telenett is seeking a Remote Utilization Review Nurse to review medical records from a home office and determine medical necessity and care appropriateness... ...for clients nationwide. Ideal candidates have a Texas RN license, 3+ years of clinical experience, strong medical...Remote workHome office
- ...WellSense Health Plan is seeking an Inpatient Utilization Management Clinician for a fully remote role in the... ...drive optimal outcomes. Qualifications include an active RN license, nursing degree, and 2 years of utilization review experience with InterQual. #J-18808-Ljbffr...Remote work
- ...The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and... ...Current Nursing licensure in the state of operation required;RN is required unless local state regulations permit LVN/LPN 4...Minimum wageWork at officeLocal areaRemote workFlexible hours
- ...Plans, Hanover, MD 21076 Category: Nursing Schedule: Day Shift Employment Type:... ...hours are 8:00 AM - 5:00 PM As a Utilization Review Registered Nurse for Johns Hopkins Health... .... Unencumbered Registered Nurse (RN) license in Maryland (or Compact state)...Full timeLocal areaRemote workWork from homeMonday to FridayDay shift
$78k - $88k
...Gainwell Technologies is seeking a skilled Utilization Review Nurse to perform prior authorization across prospective, concurrent, and retrospective... ..., requires 3+ years inpatient experience and an active RN license in the U.S. Core hours 8:00 AM–6:00 PM ET; occasional...Remote work$27.02 - $48.55 per hour
...Position Purpose: Performs reviews of member's care and health status of Applied Behavioral... ...Mental Health Professional), or RN (Registered Nurse) with state licensure and/or compact... ...data to improve quality and appropriate utilization of services Interacts with BH...Hourly payFull timePart timeWork at officeRemote workMonday to FridayFlexible hours- A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization... ...discharge planning. Candidates must have an active RN license in New Jersey, strong analytical skills, and the...Contract workRemote work
- ...Molina Healthcare is seeking an RN Care Review Clinician to support Medicaid members during hospital stays, coordinating discharge to... ...documentation and UM policy adherence. Preferred candidates have utilization management or case management experience, with strong...Work at officeRemote workMonday to Friday
$41 per hour
...Pay: $41/hour Job Responsibilities: RN working in the insurance or managed care... ...for performing accurate and timely medical review of claims suspended for medical necessity,... ...and prioritization skills. # Registered Nurse (RN) with unrestricted license in the...Contract workRemote work- ...Optum is seeking a Utilization Review Nurse, RN to manage inpatient utilization review and preauthorization requests. The role requires documentation of clinical reviews, applying medical necessity criteria, and coordinating with Medical Directors. Remote options are...Remote work
- ...A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote workFlexible hoursWeekend workDay shift
- ...leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and...Full timeRemote work
- ...Concierge Home Care is seeking an experienced Utilization Review Specialist (RN) for a fully remote role. You will review home health documentation, audit OASIS and care plans, and ensure coding accuracy to protect reimbursement integrity. Qualified candidates hold an...Remote work
$1,640 - $1,787 per week
...Supplemental Health Care is seeking a travel nurse RN Acute Care Case Management for a travel nursing job in Boston, Massachusetts... ...Health Care is hiring experienced Non-patient Care (utilization Review) RNs for contract opportunities at a leading Level 1 trauma...Contract workLocal areaImmediate startShift work$93.18k - $136.95k
...Overview Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse. The Utilization Review Nurse is responsible for utilization... ...skills Keywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management,...Full timeTemporary workRemote workShift work$35 - $40 per hour
...0/hr Location Fully Remote Position Summary The Utilization Review Nurse serves as a key liaison in coordinating resources and services... ...or vocational nursing. Current, active nursing license (RN, LPN, or LVN) in good standing with the Arizona Board of...Contract workRemote workFlexible hoursWeekend work$55 per hour
...Akkodis Akkodis is hiring a Concurrent Review Nurse to support our client in the Healthcare... ...Preferred: Experience in case management, utilization management, or discharge planning. Experience... ...clinical judgment within the scope of RN practice in California. Ability to...Full timeContract workTemporary workLocal areaRemote work- ...need to have an Illinois state RN license Assess and analyze... ...teams Summary Works with the Utilization Management team primarily responsible... ...medical necessity/utilization review and other utilization... ...unrestricted IL State Registered Nursing (RN) license in good standing....Contract workRemote work
$29 - $52 per hour
...UnitedHealth Group's Optum unit is seeking a Utilization Review Nurse, RN to perform inpatient utilization management with evidence-based guidelines and medical necessity criteria. The role emphasizes timely review, documentation, and collaboration with physician leadership...Hourly payRemote workWeekend work- ...etc). Requirements: ~2 years of staff nurse experience performing care for hospitalized patients. ~2 years of utilization review (UR) experience reviewing hospital admissions... ...Louis. ~ Have both Missouri and Illinois RN licenses. ~ If candidate only has one...ReliefLocal areaRemote workMonday to FridayFlexible hoursShift work
$78k - $88k
...Summary We are seeking a skilled Utilization Review Nurse to conduct prior authorization, prospective, concurrent, and retrospective reviews for... ...feedback, and stay updated on clinical guidelines. Maintain RN license and meet continuing education requirements. What we'...Full timeContract workWork at officeRemote workWork from homeFlexible hours- ...Overview Title: Clinical Review Nurse – Prior Authorization Review Location: Fully Remote... ...Prior Authorization Review to join our Utilization Management team. In this role, you will... ...assigned Qualifications ~ Active RN license (WA; must be in good standing)...Contract workRemote work
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