Utilization Review RN: Medical Necessity & Denials
Ensemble Health Partners
Ensemble Health Partners is seeking a qualified Utilization Review RN to support our nationwide health system clients. This role focuses on medical necessity determinations, admissions reviews, and collaboration with care management and financial clearance teams. The position operates on a 4x10 schedule with rotating weekends, offering shift differentials and a comprehensive benefits package. A current compact RN license is required or must be willing to obtain one. #J-18808-Ljbffr Ensemble Health Partners
$2,926 per week
...Registered Nurse (RN) | Utilization Review Location: East Elmhurst, NY Agency: Prime Staffing Pay: $2,926 per week Shift... ...-Have: Strong understanding of insurance guidelines, medical necessity criteria (e.g., InterQual or MCG), and discharge planning...MedicalFull timeContract workShift work- ...clinically orientated medical chart reviews and other... ...the medical center's utilization review plan, state and... ...record review for medical necessity. Knowledge of basic... ...meaningful manner Reviews denials and collaborates on appeals... ...Utilization Review RN - Per Diem* *...MedicalHourly payDaily paidWork experience placement
- ## Job Title:RN - Utilization Review - PT## Job Summary:RN-Utilization Review is accountable to perform... ...prospective, concurrent, retrospective, and denial management reviews by applying clinical protocols and review medical necessity criteria. Reports quality of care issues...MedicalPart timeCasual workSeasonal workShift work
$63.1k - $94.65k
...*Must have current compact RN license, or be willing to obtain... ...* Schedule Information Our Utilization Review team provides coverage... ...related to third party payers Medical Necessity Determination Conducts... ...related to third party payers Denial Management Coordinates the...MedicalWork at officeFlexible hoursShift work- Position Summary: The RN Integrated Care... ...are required to address utilization review cases. Roles and Responsibilities... ...of cases involving medical decisions and quality... ...support the medical necessity review process and... ...reimbursement, and claim denials/appeals. Employ...MedicalLive inRemote workFlexible hoursWeekday work
$55 - $65 per hour
...Registered Nurse With Utilization Review ExperienceA healthcare organization is seeking a Registered... ...and requires an active New York State RN license. The ideal candidate will have... ...reviewing healthcare services for medical necessity, appropriateness, and utilization....MedicalHourly payContract work$50 - $55 per hour
...RN – Utilization Management New York, NY – Midtown $50–$55/hour... ...Bachelor’s degree ~3+ years of Medical/Surgical nursing experience... ..., including medical necessity reviews, prior authorizations, appeals... ...with Medical Consultants on denials and clinical determinations...MedicalPermanent employmentTemporary workMonday to Friday- ...RN - Utilization Review About the Position Specialty: RN Utilization Review Experience: 2+ years of experience in utilization review... ...Must-Have: Strong understanding of insurance guidelines, medical necessity criteria (e.g., InterQual or MCG), and discharge planning...Medical
- 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,...MedicalHourly payDaily paid
- Molina Healthcare is seeking an RN reviewer to support clinical member services review and assessment processes in Kentucky. You will verify medical necessity and alignment with guidelines, policies, and regulations to promote integrated care. The role requires hospital...Medical
- The MetroHealth System in Ohio seeks an experienced Utilization Management Nurse at MetroHealth Medical Center. You will advocate for patients to ensure services... ...policies and care teams. Analyze medical records, review criteria, and engage with clinicians to support...Medical
$71.2k - $115.7k
...not limited to: Review and resolve complex... ...processing issues and utilization management cases,... ...and timely Medical Review processing... ...coverage and medical necessity per established criteria... ...and potential denials with the Medical Directors... ...and clinical RN - Registered Nurse...MedicalTemporary workPart timeWork experience placementInternshipSeasonal workWork at office- AvonRisk LLC is seeking a Medical Case Management nurse in Texas for a hybrid role combining case management and utilization review. The nurse coordinates care, communicates with providers, the injured worker, and employer to achieve optimal medical and disability outcomes...Medical
$38.11 - $98.61 per hour
## Utilization Review Registered NurseApply: Beth Israel Deaconess Medical Center: Full time: Posted Today: JR104618**When you join... ...physician, the Utilization Review RN assists in determining the... ...admissions is based on medical necessity and documentation is sufficient...MedicalHourly payFull timeLocal areaShift work- ...Monday - Friday from 8am-4:30pm. Requirements 2 years of RN experience performing care for hospitalized patients 2 years of Utilization Review (UR) experience reviewing hospital admissions for medical necessity Must live within one hour of the BJC Commons (4249...MedicalFull timeReliefLocal areaRemote workMonday to FridayFlexible hoursShift work
- ...Job Title: RN - Utilization Review (000298) Duties: 1 year of non-acute utilization review experience - required RN experience - preferred This... ...like: Stipends (for clinical traveler workers only), Medical, Dental, Vision, 401K [include any compulsory benefits such...Medical
- ## Registered Nurse (RN) Manager - Utilization Review - FT/Day - AugustaApply: Onsite: AU Medical Center, Inc.: Full time: Posted Yesterday: JR-75604How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion...MedicalFull timeContract workLocal areaShift work
- ...seeking a Registered Nurse to coordinate utilization/benefit management for health plans in a remote US role. The candidate will review authorizations, coordinate care plans,... ...communicate with providers to ensure medical necessity and appropriate levels of care. Strong...MedicalRemote job
- Sanford Health in Sioux Falls, SD is seeking a Registered Nurse to conduct level of care medical necessity reviews within patient records. You will perform utilization management activities to assure compliance with accreditation and regulatory requirements, and support...MedicalRemote job
$77.08k - $119.47k
## Utilization Review NurseApplylocations: 43 New Scotland Avenue Albany, NY 12208time type: Full timeposted on: Posted Todayjob requisition... ...improvement in both areas. • Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures...MedicalShift work- ...Requirements The Nurse Reviewer performs complex medical record reviews of... ...a Registered Nurse (RN); active compact multistate... ...judgment to medical necessity, coverage, and... ...reviews and/or utilization review Preferred Qualifications... ...for payment or denial recommendations...MedicalContract workFor contractorsLocal areaRemote work
- Centene Corp. is seeking a Clinical Review Nurse for concurrent reviews in a fully remote... ...and Marketplace members. Requires RN or LPN licensure, nursing degree, and 2+... ...preferred. You will assess level of care, medical necessity, discharge planning, and collaborate with...MedicalRemote jobMonday to Friday
- Molina Healthcare is seeking a nurse reviewer to evaluate documentation for medical necessity and appropriate level of care, applying MCG/InterQual, billing and coding rules, and Molina policies to ensure proper reimbursement to providers. The role involves reviewing claims...Medical
- ...POSITION SUMMARY The Utilization Review Specialist is responsible... ...clinical services are medically necessary,... ...documentation supporting medical necessity for requested services... ...approvals, denials, limitations, and other... ..., CASAC-AC, CASAC-MC, RN, or another Qualified...MedicalSecond jobWork at officeLocal area
- Allegheny Health Network seeks an RN Utilization Review professional to obtain pre-certifications, coordinate authorizations and manage denials for a seamless patient care continuum. You will liaise with third party payers, clinicians and care teams to ensure appropriate...Remote job
- Utilization Review Specialist- Healthcare | Raleigh Oaks Behavioral Health... ...management. Appeals all denials ensuring accuracy of information... ...stay criteria and medical necessity updates. Communicates effectively... ...Current licensure as an LPN or RN or current clinical...MedicalTemporary workWork at office
- ...Clinical CM to provide operational supervision of clinical staff performing utilization reviews and specialty reviews using InterQual criteria. You will mentor reviewers, ensure medical necessity decisions are accurate, and maintain regulatory compliance while...MedicalRemote workFlexible hours
- Utilization Reviewprovides clinically-based care management... ...criteria to confirm medical necessity for admission and... ...criteria and promptly reviews the case with the patient... ...payers to anticipate denial of payment and proactively... ...setting. Valid RN Licensure for State Of...Medical
$2,505 per week
...Cross Country Nurses is seeking a travel nurse RN Utilization Review for a travel nursing job in Astoria, New York. Job Description & Requirements ~ Specialty: Utilization Review ~ Discipline: RN ~ Start Date: 10/19/2026 ~ Duration: 8 weeks ~37.5 hours per...Shift work$75 - $85 per hour
# Claims Review Nurse (59863)Fully Remote • Remote - Remote Employees... ...providing independent medical reviews, records/data management... ...objective assessments of medical necessity, appropriateness of care,... ...procedure at issue in a dispute.* Utilize governmental and professional...MedicalFull timeRemote work
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