RN Utilization Review Specialist
University of South Alabama Health
University of South Alabama Health System seeks an experienced Registered Nurse for Utilization Review to perform quality reviews, prior authorizations, and discharge planning. The role collaborates with physicians and care teams to ensure compliant, timely patient care and optimal reimbursement from third-party payors. The position requires an Alabama RN license, with a Bachelor's degree in Nursing preferred and Utilization Review experience preferred. #J-18808-Ljbffr
Vacancy posted 6 hours ago
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$110k
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Brooklyn, NY2 days ago - ...Utilization Review Specialist – North Little Rock, AR (72113) Are you an experienced healthcare professional looking for an opportunity to make a difference in patient care management? We’re seeking a Utilization Review Specialist to join our team in North Little Rock,...SuggestedWork at office
The Springs Living
Brooklyn, NY1 day ago - ...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...Suggested
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Brooklyn, NY2 days ago - CHOC Children's in Orange, CA is seeking a Utilization Review Representative to review inpatient and outpatient statuses and process authorization requests with payors in collaboration with RN Care Managers. This role ensures accurate data, insurance verification, and effective...Suggested
- FHE Health in Florida seeks an experienced UR Specialist who will manage clinical authorization processes with insurance payers to... ...Bachelor's degree in Nursing or related field and 2-3 years of utilization review experience in behavioral health or #J-18808-Ljbffr...Daily paid
- ...RN - Utilization ReviewNumber of Positions: 1Remaining Positions: 1Duties: 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...
Compu-Vision Consulting
East Elmhurst, NY5 days ago $55 - $65 per hour
...Registered Nurse With Utilization Review ExperienceA 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 healthcare...Hourly payContract workATRIA Consulting
East Elmhurst, NY4 days ago- ...RN - Utilization Review Number of Positions: 1 Remaining Positions: 1 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...
Compu-Vision Consulting
East Elmhurst, NY3 days ago - ...Performs clinically orientated medical chart reviews and other administrative tasks to meet the requirements of the medical center's utilization review plan, state and federal... ...WELCOMING YOU TO OUR TEAM!! Utilization Review RN - Per Diem* *IMPORTANT NOTE: In lieu of benefits...Hourly payDaily paidWork experience placement
Carson Valley Health
Brooklyn, NY2 days ago - Meadville Medical Center in Meadville, PA is seeking a qualified RN to support Utilization Management and clinical documentation efforts on-site. The role focuses on evaluating medical necessity, coordinating care, and ensuring accurate documentation. External candidates...Relocation package
- RN - Utilization Review Shift: Days Shifts Per Week: 5 Scheduled Hours: 40 Start Date: 09/14/2026 End Date: 11/07/2026 Duration: 8 Week(s) City: Elmhurst State: NY VOCA HealthcareShift work
- ...Job Summary We are seeking an experienced Registered Nurse (RN) - Utilization Review to evaluate the medical necessity, appropriateness, and level of care for patients. The RN will review clinical documentation, apply established medical guidelines, and collaborate...
Orison Solutions
East Elmhurst, NY6 days ago - RN - Utilization Review Shift: 5 Day Shifts X 8 Hrs Start Date: 09/21/2026 End Date: 11/14/2026 Duration: 8 Week(s) City: East Elmhurst State: NY TALENTShift workDay shift
- 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...
- L.A. Care Health Plan in Los Angeles, CA is seeking a Utilization Management (UM) Claims Review Nurse RN II to evaluate medical claims for medical necessity, documentation, and proper coding. This role supports payment integrity through pre-payment and retrospective reviews...
- Carson Valley Health in Nevada seeks a Per Diem Utilization Review RN to perform clinically oriented medical chart reviews and support the hospital's utilization review plan, ensuring medical necessity and proper documentation. Requirements include Nevada RN licensure,...Hourly payDaily paid
- ...of Charity Hospital in Buffalo, NY seeks a Registered Nurse, Utilization Review, to join the middle revenue cycle and interdisciplinary care team... ...manage third-party payer relationships and inquiries. BSN or RN with a BS, NYS RN license, CCM certification within one year,...
- ...delivering patient-centered care to each and every patient each and every day. Job Description: Position Summary and Purpose The Utilization Review RN performs activities which support the Utilization Management functions. They are responsible for the delivery of the...Work at officeShift work
- ...Requirements include graduation from an accredited school of nursing, Indiana RN licensure with current BLS, and at least two years of hospital clinical experience. Preferred: utilization review, case management, discharge planning, DRGs, or CMS Swing Bed experience. We...
$60.2k - $107.4k
Optum is a global healthcare organization empowering care through technology. The Utilization Management Nurse role involves reviewing medical records, extracting case details, and crafting defensible appeal letters according to process instructions and guidelines. The...Remote jobFull timeMonday to Friday$77.02k - $117.58k
...named one of the Tampa Bay Times’ Top Workplaces. Summary The Utilization Review Nurse is responsible for performing initial, concurrent, and retrospective... ...Needed: Yes Minimum Licensure: Registered Nurse (RN) Minimum Licensure (Other): Knowledge of utilization management...Full timeWork at office- ...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...
- Hilo Benioff Medical Center is seeking an experienced Registered Nurse IV to join our Utilization Review team. This role ensures medical necessity and appropriate level of care while supporting reimbursement through clinical reviews. The ideal candidate brings strong clinical...
$88.85k
...income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Claims Review Nurse RN II is responsible for conducting clinical review of medical claims to ensure services were medically...Full time- ...Job Description Join our team as a day shift/variable, full time, RN Case Manager - Utilization Review, at INTEGRIS Baptist Medical Center, Oklahoma City, OK. Join our team as a day shift/variable, full time, RN Case Manager - Utilization Review, at INTEGRIS Baptist Medical...Full timeWork at officeDay shift
INTEGRIS Health
Brooklyn, NY2 days ago - ...BlueCross BlueShield South Carolina subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews and determine medical... ...established guidelines. The role documents decisions and supports utilization review across multiple services. The position is remote,...Remote jobFull time
- Beyond Blue is seeking a Supervisor, Utilization Review to lead the daily operations of the utilization review team in the UK. The role ensures compliance with payer guidelines and regulatory standards while guiding staff performance and quality assurance. Responsibilities...
- 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
- Comagine Health in Alabama is seeking Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective utilization reviews. This is a full-time remote role supporting Alabama contracts. You will apply...Remote jobFull time
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