Utilization Review Nurse
IntePros
A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and collaborating with teams to meet patient needs. Candidates must possess a nursing license and have experience in utilization review or home health. This contract role offers a chance to manage healthcare quality efficiently while working remotely. #J-18808-Ljbffr
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Utilization Review Nurse in United States vacancy
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Fort Myers, FL9 hours ago $65.86 - $76.15 per hour
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Spokane, WA2 days ago- ...recommendations to meet QM objectives.Responsibilities:Reviews documentation and evaluates Potential Quality of... ...:3+ years of experience as an RNRegistered Nurse in state of residenceMust have prior authorization utilization experienceExperience with MedcompassSkills:MUST...Suggested
US Tech Solutions
Chicago, IL1 day ago - ...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 and knowledge of accreditation standards. Candidates must reside...SuggestedFull timeRemote work
Innovative Systems Group
Richardson, TX3 days ago $41 per hour
...position is responsible for performing accurate and timely medical review of claims suspended for medical necessity, contract... ...Organizational skills and prioritization skills. # Registered Nurse (RN) with unrestricted license in the state. #3 years clinical...Contract workRemote workHireOps Staffing, LLC
United States5 days ago- A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization management, reviewing medical records, and coordinating discharge planning. Candidates must have an active RN license...Contract workRemote work
Rangam
Pennington, NJ1 day ago - ...Excellus BCBS in New York is seeking a Utilization Management professional to coordinate, integrate, and monitor BH or PH service utilization for members. The role requires RN licensure in NYS, an associates degree, and at least three years of clinical experience. You...
Excellus BlueCross BlueShield
Albany, NY5 days ago - ...Comagine Health is seeking a remote clinical reviewer to evaluate medical necessity for behavioral health services across a national footprint. The role requires applying evidence-based criteria, managing high-volume reviews, and documenting outcomes within the EMR. You...Full timeRemote work
COMAGINE HEALTH
Portland, OR1 day ago - ...SUMMARY The Authorization Nurse will oversee the processing of assigned authorizations for participant care, supplies, and other related... ...’ experience in a managed care environment, preferably in a utilization related role; Must have one year of experience with a frail,...Work at office
PACE Southeast Michigan
Southfield, MI5 days ago - ...A leading healthcare provider in Palos Heights is seeking an RN Utilization Specialist to ensure effective patient care through utilization review and collaborations. Responsibilities include monitoring admissions, collaborating with clinical teams, and analyzing data...
Northwestern Medicine
Palos Heights, IL5 days ago - ...Responsibilities Lighthouse Care Center of Augusta is seeking a dedicated, compassionate Utilization Review Nurse, RN to add to our growing team. Lighthouse Care Center of Augusta Lighthouse Care Center of Augusta (LCCA) is a multi-discipline behavioral healthcare center...Work at officeLocal area
Universal Hospital Services
Brooklyn, NY2 days ago - ...UofL Health, Inc. in Louisville is seeking an Utilization Review RN to support the UM process. The role focuses on determining medical necessity for admission and continued stay, aligning care with payer guidelines, and coordinating with physicians and case managers for...
UofL Health, Inc.
Louisville, KY4 days ago - Prandocin-Iły (pow. krakowski) Nasze wymagania Wykształcenie średnie (preferowane techniczne: mechaniczne lub pokrewne) Doświadczenie w obsłudze i eksploatacji maszyn produkcyjnych Reagowanie na awarie, komunikacja ze stronami, których dotyczy problem oraz skuteczne usuwanie...Weekend work
Amplus Corp
Poland, NY3 days ago - ...A leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services. Responsibilities include processing authorization requests, ensuring compliance with Medicare guidelines, and collaborating with...Remote work
Medix
New York, NY3 days ago - ...staff (commercial, behavioral health, inpatient, etc). Requirements: ~2 years of staff nurse experience performing care for hospitalized patients. ~2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity. ~ Must live...ReliefLocal areaRemote workMonday to FridayFlexible hoursShift work
BJC HealthCare
Saint Louis, MO5 days ago $78k - $88k
...Gainwell Technologies is seeking a skilled Utilization Review Nurse to perform prior authorization across prospective, concurrent, and retrospective reviews for medical necessity, documenting findings and ensuring policy compliance. This home-based role supports providers...Remote workGainwell Technologies
Juneau, AK1 day ago$22.5 - $27.5 per hour
...while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration. Overview The Contractual Reviewer-Senior will be responsible for providing an organized, timely and consistent review and investigation of provider and/or member...Hourly payContract workIndependent Health Association
Buffalo, NY2 days ago$90k - $107k
...Mass General Brigham Health Plan Holding Company, Inc. is seeking a Remote UM Nurse to support network adequacy review and authorization activities for members in ACO, HMO, and EPO products. The role requires clinical knowledge to review prior authorization requests,...Remote workyour Jared
Brooklyn, NY1 day ago- ...Boston Medical Center is seeking an experienced utilization management RN to support admitting teams in determining patient status and optimizing hospital resources. You will review clinical information using InterQual/MCG guidelines to ensure medical necessity, length...
Boston Medical Center
Baltimore, MD5 days ago - ...Utilization Review ManagerIn this role, you will manage utilization review processes, ensuring quality patient care while optimizing resource use. Your responsibilities include assessing patient eligibility, coordinating with healthcare teams, and utilizing EMR systems...Remote workMonday to FridayWeekend work
Slate Healthcare
Fort Myers, FL3 days ago - Job TitleThis 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...Contract workRemote work
HireOps Staffing LLC
Dallas, TX4 days ago - ...A healthcare provider is seeking a Utilization Review Nurse to coordinate resources and ensure efficient delivery of home health care. This role involves monitoring patient admissions and ongoing care while ensuring adherence to guidelines. The ideal candidate will have...Contract workRemote work
IntePros
United States5 days ago - ...You will perform frequent case reviews, check medical records and speak with care providers... ...RN license as defined by the Nurse Licensure Compact (NLC) Associate Degree... ...licenses to meet business needs 1+ year of utilization review experience in a managed care setting...
Medix
Phoenix, AZ5 days ago $2,487 - $2,717 per week
...Registered NurseJob Details Profession: Registered Nurse Pay: $2,487.00 to $2,717.00 weekly Assignment Length... ...for Medicare and Medicaid Services, Concurrent Review, Continued Stay Reviews, Medical Necessity, Utilize InterQual Criteria Facility Info: Log in to view details...Aya Healthcare
Orange, CA3 days ago$77.08k - $119.47k
...$119,466.00 Responsibilities Completes Utilization Management and Quality Screening for assigned... ...standards. While performing utilization review identifies areas for clinical... ...team. Minimum Qualifications Registered nurse with a New York State current license. Associate...Shift work100 Albany Med Health System
Albany, NY5 days ago- ...Center for Care Coordination-Team Lead Utilization Review Nurse- Full Time Hartford, CT, United States (Hybrid) About Us Connecticut Children’s is the only health system in Connecticut that is 100% dedicated to children. Established on a legacy that spans more than 10...Full timeWork at officeMonday to FridayShift workAfternoon shift
Connecticut Children's Medical Center
Hartford, CT1 day ago $29 - $52 per hour
...UnitedHealth Group's Optum unit is seeking a Utilization Review Nurse, RN to perform inpatient utilization management with evidence-based guidelines and medical necessity criteria. The role emphasizes timely review, documentation, and collaboration with physician leadership...Hourly payRemote workWeekend workColorado Psychiatric
Sacramento, CA2 days ago$30.64 - $45.8 per hour
...Utilization Review NurseThe Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity and assigns an appropriate length of stay while...Minimum wageFull timeWork at officeLocal areaRemote workFlexible hoursCorVel
Rancho Cucamonga, CA4 days ago$2,376 - $2,644 per week
...Utilization Review Registered NurseSupplemental Health Care is connecting Utilization Review Registered Nurses with top-tier hospital contracts in Escondido, California. Travel or stay local, either way, we'll guide you to an opportunity that matches your goals, offering...Full timeContract workLocal areaShift workSupplemental Health Care
Escondido, CA3 days ago
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