RN Utilization Review: Improve Care & Payer Alignment
100 LCMC Health
LCMC Health is seeking an RN Utilization Review nurse in Louisiana to support patient throughput and coordinate care with physicians and payers. You will perform care reviews, determine medical necessity, and document in EPIC, ensuring regulatory compliance and high-quality patient outcomes.
Evening shifts and 12-hour schedules are available. A Louisiana RN license is required, with 2 years of ED or utilization experience preferred.
#J-18808-Ljbffr- Trinity Health in Georgia is seeking a part-time Utilization Review Coordinator to support patient care across the hospital continuum. You will collaborate with... ...criteria and serving as a liaison with external payers on authorization requirements and timely service utilization...SuggestedPart time
$63.1k - $94.65k
...have current compact RN license, or be willing... ...We are seeking Virtual Utilization Review Specialist with at least... ...utilization of health care resources and assists... ...to third party payers Medical Necessity Determination... ...departmental process improvement team; planning,...SuggestedTemporary workWork at officeLocal areaRemote workMonday to FridayShift work- ...to 11pm Eastern). The Utilization Review Clinician is responsible... ...to help prevent acute care readmissions. In this... ...to support improved health outcomes. By applying... ...processes Support all payer programs and initiatives... ...therapy experience Active RN, OT, or PT license...SuggestedFull timeWork experience placementWork at officeRemote workWorldwideMonday to FridayShift work
- Medix is seeking a Remote Utilization Review Registered Nurse (UR RN) to bridge clinical care and hospital operations from a remote setting. Join... ...collaboration with care managers and payer teams, alongside ongoing process improvements and AI-enabled #J-18808-Ljbffr Medix...SuggestedRemote jobFlexible hoursShift work
$2,507 per week
...Registered Nurse (RN) | Utilization Review Location: New York, NY Agency: Infojini Healthcare Pay: $2,507 per week... ...to match you with the right role. Every assignment is carefully tailored to align your skills, specialties, and career goals with the specific...SuggestedDaily paidPermanent employmentFull timeContract workTemporary workImmediate startFlexible hoursShift work- ...Power of Every One. Job Title Utilization Management RN Reviewer Location Cleveland... ...providing clinical information to payers, UM data collection and... ...opportunities for improvement. Make recommendations regarding... ...Knowledge and experience with Care Guidelines, Medical...Full timeWork at officeRemote workShift workWeekend work
- ...days and every other weekend RN Case Manager -Utilization Review at INTEGRIS Health,... ...to appropriate levels of care as indicated by clinical needs... ...Medicaid, managed care and other payer regulations and benefit... ...utilization and Quality Improvement reporting. * Works...Full timeWork at officeRemote workWeekend work
- ...Memorial Hospital, Inc. is seeking an experienced RN to lead utilization review activities at our Hamilton, NY facility. You... ...to determine medical necessity and level of care. Work with physicians, case managers, and payers to obtain authorizations, report delays, and support...
- 100 LCMC Health is seeking an RN for Utilization Review to support patient throughput and physician communication while ensuring payer requirements are met. Responsibilities include care reviews, medical necessity determinations, and accurate status assignments per CMS...Shift workWeekend work
- ...Are you an RN looking to transition into or grow your career in Utilization Review? We're seeking a clinically strong... ...for nurses with acute care experience who enjoy... ...and opportunities to improve patient outcomes. Monitor... ...regulatory and payer requirements. Four 10-...Temporary workRemote work10 hours per weekShift workWeekend workAfternoon shift
$85k - $95k
...and pre-admission reviews to determine medical... ...and level of care. Evaluate clinical... ...ensure appropriate utilization of services according... ...standards, and payer requirements. Provide... .... Support quality improvement initiatives... ...Registered Nurse (RN) licensure Prior experience...Shift work- ...Center is seeking an Assistant Utilization Coordinator to assist in... ...Quality Management, Utilization Review, and Discharge Planning programs... ...incidents, and supporting improvements to ensure compliance with accrediting... ...should hold an active NY RN license, with at least three...
$31 - $35 per hour
Clinical Review & Correspondence RN The Clinical Review & Correspondence... ...in supporting utilization management... ...evidence-based, align with regulatory and... ...high-quality care, regulatory compliance, and improved member outcomes.... ...that streamlines payer-provider decision...Full timeRemote workFlexible hoursShift work- Community Care is seeking a Registered Nurse to perform utilization review and coordinate care for members across the health care continuum. You will assess medical... ...findings to providers, and participate in quality improvement initiatives. #J-18808-Ljbffr Community Care
$47.03 - $63.48 per hour
...redefining the possible in healthcare. The RN, Senior Utilization Review Quality will play an essential role... ...and making recommendations for improvement to the operational and executive leaders... ...years nursing experience in an acute care environment required Utilization...Temporary workWork at officeLocal areaRemote work$69.8k - $125.9k
...Nurse Liaison I - Utilization Management & Quality Review - Remote### Nurse Liaison... ..., and process improvements while ensuring clinically... ...* Registered Nurse (RN) with an... ...knowledge of managed care principles.* Analytical... ...experience. This role aligns with an annual incentive...Full timeRemote workNight shift- Currently seeking a Utilization Management RN . Please see details and qualifications... ...through medical record review to determine medical... ...to ensure appropriate care settings. Report... ...utilization trends and recommend improvements. Ensure requests align with member benefit...Immediate startRemote workDay shift
- HonorHealth in Phoenix is seeking an Utilization Review RN Specialist to review and monitor utilization, ensuring medically necessary care and appropriate discharge planning within Medicare, AHCCCS, Self-pay, and other payer guidelines. The ideal candidate has an RN license...Remote job
- ...Health is seeking a Case Manager, RN - Utilization Review (PRN) to evaluate medical necessity and appropriate care, securing authorizations and... ...based criteria, and participate in quality improvement initiatives while maintaining regulatory alignment and #J-18808-Ljbffr...ReliefRemote work
- ...HealthEdge seeks a motivated Utilization Review RN to perform prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory... ...services to ensure medical necessity and appropriate care levels. The role includes discharge planning, care coordination...Contract workRemote work
- ...highest standard of care to our patients.... ...advance healthcare and improve lives. Apply today... ...supervisor or manager of Utilization Management. The... ...appropriate level, and aligns with regulatory and payer requirements. The UM... ...and concurrent reviews to determine medical...Full timeRemote workDay shift
$47.37 per hour
...Lancesoft is seeking a Care Review Clinician for a remote 3-month assignment. You will work with the Utilization Management team to review inpatient cases, authorize care, and ensure... ...regulations. The role requires an active RN/LPN/LVN license and 2–4 years of clinical...Hourly payRemote work- ...Registered Nurse (RN) - Utilization Management - PRN - North... ...conducting medical necessity reviews up to 12 hours per day... ...with the care team on the coordination... ...specific units/and or payer/and or patient class.... ...continuous performance improvement initiatives based on identified...Part timeReliefShift work
- ...portfolio of integrated health care plans and related services,... ...specific to the LTSS department. RN will be responsible for... ...authorization and concurrent review. Provides monthly telephonic outreach... ...appropriateness of treatment setting by utilizing the applicable medical policy...Contract workRemote workMonday to FridayFlexible hours
- ...seeking a Registered Nurse (RN) for Utilization Management on a PRN basis... ...conducts medical necessity reviews, collaborates with physicians and the care team, and ensures proper authorization... ...opportunities to improve care coordination and payer communications using MCG criteria...ReliefDay shift
$82.4k - $110k
...Oncology Registered Nurse (RN) to support the clinical review and validation of AI... ..., interpreting payer policy requirements,... ...feedback that improves the performance of Natera... ..., navigation, utilization review, clinical review... ...of the standard of care to protect health and...For contractorsWork at officeImmediate startRemote workWorldwide- ...Cleveland Clinic Health System is seeking an experienced Utilization Management RN Reviewer to work remotely with a focus on admission, concurrent and retrospective reviews. The role supports payer communications, data collection, and clinical decision-making to ensure...Work at officeRemote work
- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews... ...providers to ensure compliant patient care. The role emphasizes adherence to HIPAA,... ...environment. Requirements include active RN or LVN licensure, a minimum of two years...Work at officeRemote work
- ...division of American Health Partners Inc., seeks a Utilization Review Nurse to assess medical necessity and quality of care. You will support the Clinical Services... ...coordinating care for plan members. The role requires RN licensure with UR experience; CCM is a plus. The...
$50 - $55 per hour
...RN – Utilization Management Read on to find out what you will need to succeed... ...a health insurance or managed care background and strong experience on the payer side of utilization management.... ...experience, including medical necessity reviews, prior authorizations, appeals,...Permanent employmentTemporary workMonday to Friday
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