Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

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

Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Utilization Review RN: Medical Necessity & Denials in Brooklyn, NY vacancy
  • $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... 
    Medical
    Full time
    Contract work
    Shift work

    Prime Staffing

    East Elmhurst, NY
    1 day ago
  •  ...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* *... 
    Medical
    Hourly pay
    Daily paid
    Work experience placement

    Carson Valley Health

    Brooklyn, NY
    20 hours ago
  • ## 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... 
    Medical
    Part time
    Casual work
    Seasonal work
    Shift work

    University of Mississippi Medical Center

    Brooklyn, NY
    1 day ago
  • $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... 
    Medical
    Work at office
    Flexible hours
    Shift work

    Ensemble Health Partners

    Brooklyn, NY
    2 days ago
  • 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... 
    Medical
    Live in
    Remote work
    Flexible hours
    Weekday work

    Evry Healthcare Inc.

    Brooklyn, NY
    3 days ago
  • $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.... 
    Medical
    Hourly pay
    Contract work

    ATRIA Consulting

    East Elmhurst, NY
    2 days ago
  • $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... 
    Medical
    Permanent employment
    Temporary work
    Monday to Friday

    Green Key Resources

    Manhattan, NY
    7 hours ago
  •  ...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

    PSNYC

    East Elmhurst, NY
    20 hours ago
  • 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,... 
    Medical
    Hourly pay
    Daily paid

    Carson Valley Health

    Brooklyn, NY
    20 hours ago
  • 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

    Molina Healthcare

    Brooklyn, NY
    2 days ago
  • 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

    MetroHealth

    Brooklyn, NY
    2 days ago
  • $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... 
    Medical
    Temporary work
    Part time
    Work experience placement
    Internship
    Seasonal work
    Work at office

    Florida Blue Group

    Brooklyn, NY
    1 day ago
  • 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

    AvonRisk LLC

    Brooklyn, NY
    4 days ago
  • $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... 
    Medical
    Hourly pay
    Full time
    Local area
    Shift work

    Beth Israel Lahey Health

    Brooklyn, NY
    2 days ago
  •  ...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... 
    Medical
    Full time
    Relief
    Local area
    Remote work
    Monday to Friday
    Flexible hours
    Shift work

    BJC HealthCare

    Brooklyn, NY
    2 days ago
  •  ...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

    Compu-Vision Consulting

    Elmhurst, NY
    4 days ago
  • ## 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... 
    Medical
    Full time
    Contract work
    Local area
    Shift work

    Wellstar Health System, Inc.

    Brooklyn, NY
    1 day ago
  •  ...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... 
    Medical
    Remote job

    HealthEdge Software, Inc.

    Brooklyn, NY
    20 hours ago
  • 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... 
    Medical
    Remote job

    Good Samaritan Society

    Brooklyn, NY
    1 day ago
  • $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... 
    Medical
    Shift work

    Albany Medical College

    Brooklyn, NY
    4 days ago
  •  ...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... 
    Medical
    Contract work
    For contractors
    Local area
    Remote work

    Commence, LLC

    Brooklyn, NY
    3 days ago
  • 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... 
    Medical
    Remote job
    Monday to Friday

    Centene Corp.

    Brooklyn, NY
    8 hours ago
  • 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

    Molina Healthcare

    Brooklyn, NY
    3 days ago
  •  ...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... 
    Medical
    Second job
    Work at office
    Local area

    Regional Economic Community Action Program

    Brooklyn, NY
    2 days ago
  • 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

    Highmark Health

    Brooklyn, NY
    1 day ago
  • 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... 
    Medical
    Temporary work
    Work at office

    Summit BHC

    Brooklyn, NY
    1 day ago
  •  ...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... 
    Medical
    Remote work
    Flexible hours

    Comagine Health

    Brooklyn, NY
    5 days ago
  • 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

    Coral West Community Hospital

    Brooklyn, NY
    2 days ago
  • $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

    Cross Country Nurses

    Astoria, NY
    16 days ago
  • $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... 
    Medical
    Full time
    Remote work

    Capitol Bridge, Llc

    Brooklyn, NY
    4 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Utilization Review RN: Medical Necessity & Denials. Be the first to apply!