RN Utilization Review
AMN Healthcare
Job TitleWith level of care screening criteria such as MCG or Interqual, CMS regulations as related to hospital admissions, utilization management or utilization review, and interfacing with health care payers/regulatory agencies.
Vacancy posted 4 hours ago
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Syracuse, NY1 day ago- HUMBLE VASCULAR SURGICAL CENTER INC in Addison, Texas, is seeking a dedicated RN Case Manager to oversee utilization reviews and discharge planning. The role involves ensuring compliance with medical necessity guidelines while collaborating with physicians and interdisciplinary...Suggested
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- A healthcare institution in Addison, TX seeks an experienced Registered Nurse (RN) to oversee the Case Management team focusing on Utilization Review. Responsibilities include managing departmental operations, ensuring compliance with regulations, and improving care coordination...Full time
- ...Description Day to Day Responsibilities: Conducts utilization management activities in accordance with... ...to calls, conducts certification reviews, facilitates the discharge planning and referral... ...AT (***) ***-**** ASAP! Qualifications RN License in NY with 2 years of experience...Hourly payCasual workPrivate practiceWork at officeImmediate startMonday to Friday
- Job Details Description Hiring Now for RN Utilization Review Coordinator Department: Case Management Shift: Full-time Hybrid Job Summary The RN Case Manager/Utilization Review is responsible for performing prospective, concurrent, and post‑discharge utilization reviews...Full timeLocal areaShift work
- A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing...Full timeRemote work
Innovative Systems Group
Richardson, TX5 days ago - Job PostingBenefits We Offer:Comprehensive health, prescription, dental, vision, life, and disability plansCompetitive pay ratesReferral opportunities ? Refer a friend & Cash in!Travel reimbursement and per diem allowancesEmployee discountsEducational opportunitiesHealth...Daily paidLocal area
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Syracuse, NY5 hours ago $40 per hour
...time remote Candidates must be based in TX. RN working in the insurance or managed care... ...for performing initial, concurrent review activities; discharge care coordination for... ...guidelines. Provides information regarding utilization management requirements and operational procedures...Contract workWork at officeRemote workHireOps Staffing LLC
Dallas, TX4 days ago$35 - $45.94 per hour
...Description Job Description Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role:... ...duties as assigned Requirements: ~ Active, unrestricted RN licensure from the United States in [state], OR, active compact...Hourly payFull timeRemote workWork from homeHome officeWeekend workOscar Health
Dallas, TX7 days ago- Summary The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper... ...LVN license in the state of employment or compact required RN license in state of employment or compact preferred Work Schedule...Full time
- Utilization Review Nurse for Workers' Comp Job Purpose: Review Workers Compensation requests submitted by the provider, requestor, claimant or... ...Qualifications: Graduate of an accredited school Valid current RN license in good standing Able to perform the professional and...
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*Description* Methodist Surgery Center, part of the Surgery Partners network, is seeking an experienced Utilization Review Specialist to join its team in Addison, Texas. This position is ideal for someone with many years of experience doing Utilization Review who can quickly...Permanent employmentRemote work2 days per weekTEKsystems
Addison, TX1 day ago- ...About the Role The Utilization Review Coordinator plays a critical role in ensuring that patients at our facility receive the appropriate level... ...behavioral health or chemical dependency setting. Licensure: Current RN, LCSW, or LPC license preferred. Skills and Competencies: In-...Full timePart timeWeekend work
Bradford Health Services
Dallas, TX4 days ago - A healthcare organization is seeking Board-Certified physicians in Oncology for a flexible, remote utilization review role. This position requires a Medical Degree (MD or DO) with a current license in Florida, Minnesota, or Oregon, and an active Board Certification in...Remote jobFlexible hours
- ...customized health plans. What is your impact? Utilization Management (UM) nurses will provide our... ...designated. This requires an experienced RN with a diverse clinical background, as... ...nature of the diagnosis. Medical record review to determine medical necessity of requested...Temporary workPart timeWork experience placement
WebTPA Employer Services, LLC
Irving, TX23 hours ago - Methodist Surgery Center in Addison, Texas, is seeking an experienced Utilization Review Specialist to join its team. The role requires the ability to work independently with minimal training and to manage complex cases in a fast-paced environment. This is a hybrid position...Remote job3 days per week
- ...must reside in IL or TX Contract: 12/22/2025 to 03/31/2026 RN working in the insurance or managed care industry using medically... ...is responsible for performing accurate and timely medical review of claims suspended for medical necessity, contract interpretation...Full timeContract workRemote work
Innovative Systems Group
Richardson, TX1 day ago - ...This position is fully remote, however, you must reside in the State of Texas The position is a contract for about 6 months. RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness...Remote jobContract work
$16.74 - $26.92 per hour
...Job Description Job Description The Utilization Review (UR) Intake Specialist provides staff support services including typing reports and correspondence, file handling and forms completion in addition to answering incoming telephone calls, supporting the goals of...Hourly payMinimum wageFull timeWork at officeLocal areaRemote workFlexible hoursCorVel Healthcare Corporation
Dallas, TX8 days ago- ...licensure in a clinical discipline or Social Work, with previous discharge planning experience preferred. The role focuses on discharge planning, utilization reviews, and coordinating care and reimbursement for critically ill patients. #J-18808-Ljbffr Select Specialty HospitalFull timeMonday to Friday
- ...compensation model. The physicians will conduct health claim reviews and ensure compliance with Concentra's policies. Candidates must... .... Additional responsibilities include recommendations for utilization reviews and timely case management. #J-18808-Ljbffr ConcentraRemote job
- ...responsibility” assigned to the Inpatient Services RN, for a limited period of time, and for specific... ...ensure efficient patient scheduling and staff utilization in accordance with the TAP scheduling tool. Maintain and review the daily TAP tool for all hospitals/facilities...Local areaWorldwide
CH01 CHE Fresenius Medical Care (Schweiz) AG
Dallas, TX1 day ago - ...length: 13 weeks. Guaranteed hours: 36 hours/week.Active and clear RN licenseBLS, PALS, NRP certifications2+ years of NICU RN... ...Collaborate with the healthcare team to optimize patient outcomes.Utilize EPIC EMR for patient charting and management.Ensure compliance with...Contract workLocal areaShift workWeekend work
TLC
Syracuse, NY4 hours ago - ...according to facility policy.Prepares, organizes, and efficiently utilizes supplies and equipment to prevent waste.Clerical &... ...designated clinical application accurately and in a timely manner.Reviews health care record for completeness and ensures omitted entries...Immediate startFlexible hours
Fresenius Medical Care
Balch Springs, TX1 day ago $192 - $384 per day
...standards including the confidentiality of client information.Runs and utilizes capacity information to manage the number of referrals accepted... ..., physician offices and nursing home facilities.Oversee the review of clinical information, orders and other communications to...Full timePart timeWork at officeLocal areaImmediate startFlexible hoursWeekday workNascentia Health
Syracuse, NY4 hours ago- ...as needed to, the Clinical Manager/Charge RN acting as nurse manager, the Medical... ...concerns, issues, and questions including the review of patient satisfaction surveys. •... ...policies and procedures to facility staff. • Utilizes knowledge of FMCNA and FMS services and...Temporary workWork at office
Fresenius Medical Care
Dallas, TX1 day ago - ...Description Summary: The RN Navigator Home Health Review plays a crucial role in monitoring post-acute patients to ensure they continue to... ...Home Health recertification or discharge from service. Utilizes MCG Guidelines for post-acute services and Home Care to optimize...Full timeWork at officeMonday to Friday
Christus Health
Irving, TX7 days ago
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