Utilization Review RN — Denials & Appeals (Inpatient)
Capital Health Systems
Capital Health in Trenton, NJ, seeks a Clinical Denials Utilization Review RN for a full-time day shift to manage inpatient utilization for third-party reimbursement, denials, appeals, and clinical audits. The role requires RN licensure, 5+ years nursing, and 3+ years in case management with UR, discharge planning, and outcomes management. The position collaborates with HIM and billing, maintains audit records, and contributes to performance improvement initiatives. #J-18808-Ljbffr Capital Health
- ...covered by insurance. Reviews clinical criteria to support... ...required for the appeal process when... ...necessity criteria for inpatient admission and observation... ...Knowledge and experience of denials based on the absence... ...working knowledge of, utilization management, case-management...SuggestedShift work
- ...Position Summary and Purpose The Utilization Review RN performs activities which... ...regarding payor approval/denial of admission and continue... ...including observation and inpatients, identifies patients who do... ...correct payor source, denials, appeals, and system issues Other...SuggestedWork at officeShift work
- ## Job Title:RN - Utilization Review - PT## Job Summary:RN-Utilization Review... ...concurrent, retrospective, and denial management reviews by... ...of nursing experience in an inpatient setting.**Certifications, Licenses... ...rates, denials, and appeals.* Uses data to drive decisions...SuggestedPart timeCasual workSeasonal workShift work
$110k
...time frame and with the most efficient utilization of resources. Carries out activities... ...documentation for justification. Reviews the patient’s plan of care in conjunction... ...retrospective reviews on insurance denials and assists in appeal process. Qualifications Bachelor...SuggestedDaily paidFull timePart timeFlexible hoursShift work- ...orientated medical chart reviews and other administrative tasks... ...of the medical center's utilization review plan, state and... ...meaningful manner Reviews denials and collaborates on appeals of denials Communicates with... ...TEAM!! Utilization Review RN - Per Diem* *IMPORTANT NOTE...SuggestedHourly payDaily paidWork experience placement
- ...Position Summary: The RN Integrated Care Coordinator (UM) provides comprehensive... ...weekend hours are required to address utilization review cases. Roles and Responsibilities... ...certification, reimbursement, and claim denials/appeals. Employ active listening & motivational...Live inRemote workFlexible hoursWeekday work
- Optum is seeking an Utilization Management Nurse to review patient records and craft defensible appeal letters. The role requires an RN license, 3+ years bedside experience, and strong data extraction skills. You will work per diem with flexible start times and may telecommute...Remote jobDaily paidWork at officeFlexible hours
- ...exceptional care to others. As a Utilization Review Specialist joining our team,... ...care requirements for inpatient and outpatient authorization... ...services. Reports appropriate denial, and authorization... ...requirements are met. Ensure appeals are completed thoroughly and...Temporary workPart timeRelief
- Utilization Review Specialist- Healthcare | Raleigh Oaks Behavioral Health... ...of initial or additional inpatient days for treatment. Provides... ...to utilization management. Appeals all denials ensuring accuracy of information... ...licensure as an LPN or RN or current clinical...Temporary workWork at office
$2,926 per week
...Registered Nurse (RN) | Utilization Review Location: East Elmhurst, NY Agency: Prime Staffing Pay: $2,926 per week Shift Information: Days - 5 days x 8 hours Contract Duration: 8 Weeks Start Date: 10/5/2026 About the Position About...Full timeContract workShift work- ...Molina Healthcare is seeking a qualified RN to support clinical member services review and assessment processes. You will verify medical necessity, align... ...care across the continuum. The role emphasizes utilization management, adherence to timelines, and collaboration...
- ...Mesa Springs in Fort Worth, TX is seeking a dedicated Utilization Review Specialist to ensure appropriate inpatient and outpatient authorizations, accuracy in denials and certifications, and effective communication with physicians and care teams. You will apply clinical...
$88.85k
...net required to achieve that purpose. Job Summary The Utilization Management (UM) Claims Review Nurse RN II is responsible for conducting clinical review of... ...-payment review processes, helps reduce unnecessary denials, and monitors for potential fraud, waste, and abuse...Full time- Comagine Health seeks Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time, remote position requires Alabama licensure and focuses on compliant, cost-effective...Remote jobFull timeContract work
$55 - $65 per hour
...Registered Nurse With Utilization Review Experience A healthcare organization is seeking a Registered Nurse with utilization review experience... ...in the Queens, NY area and requires an active New York State RN license. The ideal candidate will have experience reviewing...Hourly payContract work$2,940.02 per month
...HHC Correctional Health Services Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 19084478 Job Title RN - Utilization Review (000298) Weekly Pay $2940.02...Weekly payShift workDay shift$2,550 - $2,630 per week
...Job Description Job Description RN – Utilization Review Location: East Elmhurst, NY 11370 Employment Type: Contract – 13 Weeks + Possible Extension Pay Rate Travel: $2,550 – $2,630 per week Local: $69 – $73 per hour Position Summary We are seeking...Hourly payContract workLocal area- MarinHealth is seeking a Utilization Review Nurse II to perform admission, concurrent and retrospective reviews for designated health plans in a 40-hour week on days at Greenbrae, CA. The role requires a BSN preferred, 3+ years of acute care experience, and experience...
$30 - $38 per hour
...expertise into life-changing decisions, one review at a time? Why This Role Matters Every... ...options when clinically appropriate. Build the appeals case: Prepare clinical summaries and... ...Education & Experience: Current, unrestricted RN license in the United States or a U.S....Hourly payImmediate startMonday to FridayFlexible hours- ...organization dedicated to improving health outcomes through care and technology. The Utilization Management Nurse will extract details from patient records and craft persuasive appeal letters per guidelines, within required timeframes. The role offers Monday-Friday, 40...Remote jobMonday to FridayFlexible hours
- ...Utilization Review Specialist – North Little Rock, AR (72113) Are you an experienced healthcare professional looking for an opportunity to... ...adherence to state, federal, and organizational guidelines. Appeals Management: Review and respond to appeals related to utilization...Work at office
- ...Plans Community Care is looking to hire a Utilization Review Nurse. The Utilization Review Nurse is... ...execution of member/provider approval and/or denial letter. Reviews provider requests for... ...- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning...Temporary workRemote workShift work
- ** OUTSTANDING OPPORTUNITY - CLINICAL NAVIGATOR - SR. UTILIZATION REVIEW NURSE II ** ** POPULATION HEALTH WORK EXPERIENCE A SIGNIFICANT PLUS... ...requirements related to medical necessity and benefit denials across the continuum of care and proactively resolving communication...Temporary workWork experience placementLocal area
$75k - $88k
...alternative application process. Clinical Reviewer RN - Alabama Alabama, US Salary Range: $7... ...Overview We are seeking Clinical Utilization Review Nurses (RN) based in Alabama to... ...nursing home, ICF/IID, swing bed, PEC, and inpatient psychiatric facilities Provider...Full timeContract workRemote work- ...Partners, Inc. leads the case management team with a strong focus on utilization review, ensuring compliant care and reducing unnecessary hospital... ...optimize care coordination and outcomes. Requirements include RN license with BSN, UR/UR-related credentials, and 3+ years...
$77.08k - $119.47k
## Utilization Review NurseApplylocations: 43 New Scotland Avenue Albany, NY 12208time type: Full timeposted on: Posted Todayjob requisition... ...and ability to implement and utilize. • Understanding of Inpatient versus Outpatient surgery and ICD10-Coding (preferred) and Observation...Shift work$100 per hour
## Physician, Concurrent Inpatient Review (PT Evenings/Weekends) (Remote) (Hospital Advocacy)Applylocations: US - Remotetime type: Part timeposted... ...to evaluate hospitalizations across the country while utilizing your medical knowledge and gaining experience as an expert...Remote jobHourly payWork at officeImmediate startWork from homeMonday to FridayWeekend workAfternoon shift$2,398.55 per week
...: Seeking a dedicated Registered Nurse with experience in utilization review to evaluate patient records and ensure proper healthcare utilization... .... Qualifications: ~Hold a valid New York State RN License. ~Possess at least 1 year of non-acute utilization...- ...RN - Utilization Review Duties: 1 year of non-acute utilization review experience - required RN experience - preferred This is the pay range that RightSourcing (a part of Magnit) reasonably expects to pay someone for this position, however, as a supplier your expected...
$160k - $300k
...managers, and payors to conduct medical necessity reviews, facilitate peer-to-peer discussions, manage appeals, and ensure appropriate patient status... ...applicable regulatory standards and CMS policy regarding inpatient admissions, observation/outpatient status, and the...Remote jobMinimum wageFull timeWork experience placementLocal areaAll shiftsFlexible hoursWeekend workAfternoon shift
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