RN Utilization Review Specialist - Care Management
phoebehealth
Phoebe Putney Memorial Hospital in Albany, GA, is seeking an RN UR Specialist to manage utilization review activities, secure authorizations, and support medical necessity justification for hospital services. You will liaise with insurance payers and care management staff, document in the electronic system, and participate in peer-to-peer discussions to prevent denials. This is an on-site, full-time position requiring GA RN licensure and UR experience. #J-18808-Ljbffr phoebehealth
- CVS Health is seeking a Utilization Management Nurse Consultant to coordinate, document and communicate... ...the member receives appropriate care at the right time and place, while adhering... ...and state turnaround times and reviewing clinical records. This full-time, remote...SuggestedRemote jobFull timeMonday to Friday
- NeueHealth is seeking a Utilization Management Prior Authorization Nurse to ensure... ...coverage and evidence-based care for assigned populations. You... ...Directors and clinicians to review authorizations for treatments... ...candidates hold a California RN license, with 2+ years in utilization...Suggested
- 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...SuggestedShift workWeekend work
- ...Nurse role involves conducting clinical reviews to assess medical necessity and... ...members. It supports the health plan’s utilization management aligned with clinical guidelines and accreditation... ...deliver cost-effective, high-quality care and regulatory compliance. #J-18808-...Suggested
- University of Miami Health System seeks a full-time Utilization Review Case Manager to work remotely. The role reviews patient charts for prior authorization... ...and retrospective utilization, coordinating with the care team for timely and appropriate care. You will manage a...SuggestedRemote jobFull time
$56.27k - $69.9k
...Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46... ...Resources has a career opening for a Utilization Management Specialist II to join our team! The Utilization... ...Management Specialist II supports clinical review by validating service authorization...Work at officeImmediate startRemote workWork from homeFlexible hours- Brighton Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes,... ...Office, and 2+ years in UM within managed care. Prior experience in various reviews and...Remote jobWork at office
- Currently seeking a Utilization Management RN . Please see details and qualifications below: Position... ...clinical conditions through medical record review to determine medical necessity for... ...or physicians to ensure appropriate care settings. Report utilization trends and...Immediate startRemote workDay shift
- Devoted Health is seeking a Clinical Guide on our Outpatient Utilization Management team to review outpatient authorization requests using evidence-based... ...and CMS requirements. You will help ensure appropriate care settings and support members navigating the healthcare...Remote jobFull time
- ...A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote workFlexible hoursWeekend workDay shift
$42 per hour
Registered Nurse (RN) - Telehealth Medicare... ...Wellness Visit Specialist - PRN Full-time... ...and a centralized Managed Service Organization... ...completed. Virtually reviewing and updating... ...chronic diseases, utilizing remote monitoring... ...practices, preventive care practices, and chronic...Bi-weekly payFull timeTemporary workFor contractorsReliefLocal areaRemote workWork from homeMonday to Friday$140 - $145 per hour
...Oscar is hiring a Physician Reviewer to join our Utilization Management Team. You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This remote role is open...Hourly payRemote workWeekend work$29 - $52 per hour
...a global organization that delivers care, aided by technology to help millions... .... Connecting. Growing together. The Utilization Review Nurse, RN is responsible for providing clinically... ...and effective Inpatient utilization management. Reviews inpatient criteria for acute...Remote jobHourly payMinimum wageFull timeWork experience placementLocal areaMonday to FridayShift work- The Utilization Management (UM) Nurse is responsible for conducting clinical reviews and assessing the medical necessity, appropriateness, and... ...cost-effective, high-quality care for members through a variety... ...unrestricted Registered Nurse (RN) license in the applicable state...
- Your job is more than a job The RN Utilization Review position allows for necessary support for patient... ...Everyday Perform appropriate level of care reviews Identify gaps or barriers in... ...plans to achieve quality and cost management objectives Document all workflows in EPIC...Shift workWeekend work
- A healthcare staffing firm is seeking a skilled Utilization Review RN to join their team. This fully remote position requires a valid PA RN license and prior experience in insurance utilization review. Responsibilities include conducting clinical reviews, applying evidence...Remote job
- LCMC Health in Louisiana seeks an RN for Utilization Review to support patient throughput, facilitate physician communication, and determine medical... ...in EPIC, identify barriers in treatment plans, coordinate care to prevent payer denials, and perform timely status...Shift workNight shiftWeekend work
$45 - $45.5 per hour
...Job Title: Nurse Case Management Senior Analyst Location... ...evaluates appropriate health care services in conjunction... ...treatment plan. Utilizes clinical skills to assess... ...concurrent, and retrospective reviews for inpatient acute... ...junior team members. RN and current...Contract workImmediate startRemote workMonday to FridayAfternoon shift- 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...Afternoon shift
$29 - $52 per hour
Optum is seeking a Utilization Review Nurse, RN, to lead inpatient utilization management, applying evidence-based guidelines and criteria to determine medical necessity for admissions and authorizations. The role requires 3+ years of clinical nursing and 1+ year in Utilization...Remote jobHourly pay$10k
## Utilization Review RN - PT - Day - Utilization Resource Mgmt Pennington NJApplylocations: Pennington... ...progressive, quality patient care with significant investments in our exceptional... ...a variety of utilization and resource management activities to promote quality,...Full timeTemporary workPart timeWork at officeLocal areaImmediate startFlexible hoursNight shift$31 - $35 per hour
Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing... ...will help support high-quality care, regulatory compliance, and improved...Full timeRemote workFlexible hoursShift work- Appworkshub is seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this... ...conduct inpatient and outpatient utilization reviews, support transitions of care, and ensure compliance with Medicare Advantage...Remote job
$65.48k - $96.89k
R1 RCM Inc. is seeking an RN Utilization Review Author to join the Physician Advisory Team, performing... ...and MCG to determine appropriate care levels. The role requires an active RN... ...and hospital-based utilization or case management experience, along with strong analytical...Flexible hoursAfternoon shift- Optum is seeking an Inpatient Care Management Nurse to assess and interpret member needs, guiding utilization of health services to improve... ...clinicians, perform case reviews, and support discharge planning... ...Requirements include an active RN license, 3+ years acute/...Remote job
- A healthcare solutions company is seeking a Utilization Management Nurse Reviewer to assess the appropriateness of medical services and collaborate with healthcare professionals. This role requires a Licensed Practical/Vocational Nurse with clinical experience and skills...
$83k - $120k
...the Minimum Data Set (MDS) and Care Area Assessments (CAAs) in... ...all regulatory requirements. Utilization Review & Triple-Check Coordination:Lead... ...medical necessity, track managed care authorizations, and ensure... ...unrestricted Registered Nurse (RN) license in the state of...Full timeTemporary workPart timeWork at officeImmediate startFlexible hoursShift work- A healthcare organization is seeking an experienced Registered Nurse (RN) - Case Management for their New York location. The RN will be responsible for coordinating patient care, managing resources, and ensuring high-quality patient outcomes. Key responsibilities include...
- ...& Prior Authorization Specialist serves as a trusted consultant... ..., account management, training, and support... ..., workshops, business reviews, and operational meetings... ...Optimization Assess customer utilization of PAHub and identify... ...needs of the managed care market with a suite of...Local areaRemote work
$80 per hour
...healthcare professionals experienced in prior authorization, utilization management, clinical review, medical necessity criteria, payer authorization... ...operations, payer operations, medical necessity review, or care coordination is highly relevantClinical licensure such as...Hourly payPart timeFor contractorsWork at officeRemote workFlexible hours
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