Utilization Review Specialist
Santa Barbara Cottage Hospital
Humana Healthy Horizons in Kentucky seeks a Utilization Management Behavioral Health Professional 2 to support coordination, documentation, and communication of medical services and benefit determinations. The role requires interpreting criteria and policies with independent judgment. Requirements include Kentucky residency (or contiguous counties), a nursing degree or a master's in Human Services with licensure, and 3+ years of post-degree clinical experience. #J-18808-Ljbffr
$39.4 - $53 per hour
...Must be available to work Monday - Friday, 8am - 5pm Central Time and every other weekend We are seeking Virtual Utilization Review Specialists to join our team. Essential job function include: Resource Utilization Utilizes proactive triggers (diagnoses...SuggestedTemporary workWork at officeLocal areaRemote workMonday to FridayWeekend work$80 per hour
...part-time consulting opportunity for United States-based healthcare professionals experienced in prior authorization, utilization management, clinical review, medical necessity criteria, payer authorization workflows, documentation review, and healthcare operations.This...SuggestedHourly payPart timeFor contractorsWork at officeRemote workFlexible hours$20 - $30 per hour
A behavioral healthcare organization is seeking a Utilization Review Specialist to conduct clinical auditing and negotiate authorizations. The ideal candidate has a Bachelor's degree in Social Work or Nursing and 1-2 years of healthcare experience. Responsibilities include...Suggested$50k
...lives of patients and their families What to Expect (Job Responsibilities) Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary treatment team to gather necessary information for concurrent reviews...SuggestedRemote job- Ensemble is seeking Virtual Utilization Review Specialists to join our remote team. You will evaluate medical necessity, coordinate with physician advisors, and collaborate with care management and financial clearance teams to ensure high-quality patient care and appropriate...SuggestedRemote job
$122.91k - $188.02k
Healthfirst is seeking a Medical Peer Reviewer based in Pennsylvania to evaluate medical necessity as part of utilization management. The role requires collaboration with various medical departments and demands flexibility in workload. The hiring range is $122,907 to $1...- Responsibilities Coastal Harbor Health is currently seeking a Utilization Review Coordinator Per Diem to coordinate and direct utilization review functions, monitoring the utilization and continuum of services to optimize reimbursement. Coastal Harbor Health System is...Daily paidTemporary workReliefLocal area
- ...related Streaming Services. Standards & Practices Associates review high profile national advertising campaigns to ensure... ...communication, claim support, and other documentation obtained and utilized in the clearance process is an integral part of this role. The...Contract workFixed term contractWork at officeRemote work
- A healthcare provider in Savannah, GA is seeking a Per Diem Utilization Review Coordinator. The role involves coordinating Utilization Review functions, ensuring timely and appropriate processes, and maintaining confidentiality. Candidates must possess a Master's degree...Daily paid
$20 - $30 per hour
...the behavioral health industry by delivering exceptional care, utilizing state-of-the-art facilities, and prioritizing the well-being of... ...Exempt Travel Requirement: None Responsibilities Utilization Review on Behalf of the Clinics: Prescreen referrals to project/...Remote work$45 - $50 per hour
Greenlife Healthcare Staffing is looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical studies. With a competitive pay of $45 - $50 per...Remote jobHourly pay$32.85 - $35.71 per hour
Broadcast Standards & Practices Associate / Ad Review Specialist 2 days ago Be among the first 25 applicants Get AI-powered advice on this... ..., claim support, and other documentation obtained and utilized in the clearance process is an integral part of this role....Fixed term contract- Perform admission, concurrent, retrospective, and Medicare reviews to determine medical necessity and support appropriate levels of... ...clinical information, and support concurrent and retrospective utilization reviews Identify quality concerns, report potential issues, and...
- 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...
- DKKD Staffing is seeking a TPRM / User Access Review Analyst for a contract role lasting 9-12 months, potentially longer. This remote/hybrid position involves supporting a third-party risk management program and user access reviews for a financial-services cybersecurity...Remote jobPermanent employmentContract work
$160k - $180k
...DescriptionWhat is the opportunity?The Associate, Corporate Banking - Power, Utilities and Infrastructure (“PU&I”) candidate will be responsible for... ...opportunity at RBC. Qualified applicants may be contacted to review their resume in more detail.Job SummaryJob number: R-0000182882...Full timeWork experience placementFlexible hours$135k - $165k
...ServiceExciting opportunity to join BMO as an Associate on the U.S. Power, Utilities and Infrastructure (“PU&I”) Corporate Banking team.BMO’s... ...client calls, analysis of business models, and comprehensive review of industry trends and related regulations.Ability to...Full timeContract workPart timeLocal area- ...Time, Mid-LevelDepartment: LegalAs a CGS Hmong Chinese Document Reviewer you will play a key role in supporting various aspects of the... ...;Produces a variety of written documents and materials utilizing a wide range of office software applications;Establishes and maintains...Full timeWork at office
$85k - $120k
...Overview We are seeking a Scheduler/ Project Controls Specialist - Utilities to join our team in Binghamton, NY. Your Role Develop... ...and over-runs. Prepare forecasts and cost trend reports.Review and evaluate trends and their impact on project costs. Monitor...Full timeTemporary workWork at officeFlexible hours- Corner Alliance is seeking Merit Reviewers with 5+ years of experience to support federal grant programs focused on broadband deployment on Tribal Lands and related remote learning initiatives. The role is remote, with reviews scheduled mid-December 2026 through spring...Remote job
- Title: Clinical Quality Reviewer Department: Quality Management Reports To: Team Lead Location: Manhattan, NY - HYBRID Education: RN... ...clinical service delivery. Responsibilities Clinical Review Utilizes clinical expertise to conduct clinical case retrospective reviews...Full timeWork at office
- ...employees. Responsibilities Empower AI: As a casual Medical Review Specialist III (Medical Reviewer III) you will primarily perform... ...payment determinations based on Insurance coverage, coding, and utilization of services and practice guidelines for Medicare A, Outpatient...For contractorsCasual workWork at officeLocal area
- ...Responsibilities Black Bear Lodge Utilization Management Coordinator Foundations Recovery Network (FRN) is the premier provider of integrated... ...Qualifications Essential Duties and Responsibilities Reviews and understands insurance information provided by the Call Center...Work at officeLocal area
- A leading construction consultancy in the United States is seeking a part-time Constructability Review Specialist to provide expert-level support in reviewing project scopes and construction packages. Candidates should have over 10 years of experience with mechanical systems...Part time
- A leading company in the digital space is seeking a Promotional Review Editor in New Jersey. The role involves conducting editorial reviews of promotional and internal materials, ensuring regulatory compliance, and facilitating discussions with regulatory advisors. Ideal...
- ...Operations Analyst to join their team, focusing on fraud prevention and risk management. This remote role involves executing customer reviews, monitoring transactions, and improving fraud operation processes. Ideal candidates will have hands-on experience in fraud...Remote job
- ABOUT THIS POSITION The Revenue Integrity Specialist position is responsible for following procedures to make corrections to client data... ...'LL DO Client Education and Success: Conduct thorough record reviews to identify opportunities for best practice process improvement...Live outLocal areaRemote workFlexible hours
- A global staff augmentation firm seeks a Broadcast Standards & Practices Associate/Ad Review Specialist in New York. The role involves reviewing advertising compliance with regulations and internal policies while maintaining detailed records. Applicants should possess strong...
- Mercor seeks a Legal Contracts Evaluator to review AI-generated artifacts, assess diligence and redlines, and provide precise feedback to improve model outputs in a fully remote contract role. The ideal candidate has 5+ years in legal contracts and diligence, native English...Remote jobContract work
- Utility Specialist 2 (Telecommunications), Grade 21 (NY HELPS) Candidates must have seven years of experience repairing, maintaining, constructing, or testing one or more of the following: cable television, broadcast television, or high powered radio frequency or microwave...Work at officeLocal area
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