Senior RN Case Management Lead - Utilization Review
Surgery Partners, Inc.
Manager of Case Management at Surgery Partners, Inc. leads the case management team with a strong focus on utilization review, ensuring compliant care and reducing unnecessary hospital stays. This role collaborates across departments to optimize care coordination and outcomes. Requirements include RN license with BSN, UR/UR-related credentials, and 3+ years hospital-based case management experience. Proficiency with EPIC and payer policies is preferred; leadership and communication skills are #J-18808-Ljbffr Surgery Partners, Inc.
$2,926 per week
...Registered Nurse (RN) | Utilization Review Location: East Elmhurst, NY Agency: Prime Staffing Pay: $2,926 per week Shift... ...Experience: 2+ years of experience in utilization review, case management, or acute care nursing License: Active State or...SuggestedFull timeContract workShift work$110k
...Nyack, New York Department: Care Management Work Shift: Day Work Days:... ...and with the most efficient utilization of resources. Carries out activities... ...for justification. Reviews the patient’s plan of care in... ...Improvement activities in the Case Management Department, making...SuggestedDaily paidFull timePart timeFlexible hoursShift work- MarinHealth is seeking a Utilization Review Nurse II to perform admission, concurrent and retrospective reviews for designated health plans... ..., 3+ years of acute care experience, and experience with case management software and Electronic Health Records. In this role you...Suggested
- ...Description: Position Summary and Purpose The Utilization Review RN performs activities which support the Utilization Management functions. They are responsible for the... ...The employee communicates with physician and case managers regarding payor approval/denial of admission...SuggestedWork at officeShift work
- ...clinically orientated medical chart reviews and other administrative... ...of the medical center's utilization review plan, state and federal... ...CCM (certification in case management) is preferred. License Required... ...TEAM!! Utilization Review RN - Per Diem* *IMPORTANT NOTE...SuggestedHourly payDaily paidWork experience placement
- ## Utilization Review NurseApplyremote type: Hybridlocations: 1301 6th Ave W - BRADENTON, FLposted on: Posted Todayjob requisition id:... ...process-driven environment. Experience in utilization review or case management is highly beneficial, particularly within workers'...Work at officeImmediate startRemote workFlexible hours2 days per week
$77.08k - $119.47k
## Utilization Review NurseApplylocations: 43 New Scotland Avenue Albany, NY 12208time type: Full... ...requisition id: 71163Department/Unit:Care Management/Social WorkWork Shift:Day (United... ...continuous improvement in both areas. • Refers cases and issues to Medical Director and...Shift work- ...Community Care is looking to hire a Utilization Review Nurse. The Utilization Review... ...is responsible for utilization management services within the scope of... ...Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA...Temporary workRemote workShift work
- EnergyHub is seeking a Senior Client Success Manager to oversee the end-to-end client relationship and drive success across a portfolio of utility clients. You will implement demand response programs, coordinate with Sales, Product, Engineering, and Marketing, and ensure...Senior
- ...Care Mgmt Clinician, Senior (RN Compact state license... ...Behavioral Health Care Management Clinician, Senior helps... ...Work Collaborate with case managers and other team... .... Interacts with Utilization department and Physician... ...change with periodic reviews. Physical Requirements...SeniorFull timePart timeWork at officeLocal areaWork from homeHome office2 days per week
- ...JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation... ...active team member of the Utilization Management Team. KEY RESPONSIBILITIES: Performs... .... Appropriately identifies and refers cases that do not meet established clinical...
$55 - $65 per hour
...Registered Nurse With Utilization Review Experience A healthcare organization... ...an active New York State RN license. The ideal candidate... ...established utilization management criteria, policies, and clinical... ...team members regarding cases under review. Qualifications...Hourly payContract work- ...Molina Healthcare is seeking a qualified RN to support clinical member services review and assessment processes. You will verify medical necessity... ...integrated care across the continuum. The role emphasizes utilization management, adherence to timelines, and collaboration with...
- UCLA Health is seeking a Senior Case Manager in the Patient Navigation and Business Services team to coordinate care for international patients. You will review referrals, assess medical records, and arrange MD-to-MD case reviews with doctors abroad and locally to ensure...Senior
- RN - Utilization Review Shift: Days Shifts Per Week: 5 Scheduled Hours: 40 Start Date: 09/14/2026 End Date: 11/07/2026 Duration: 8 Week(s) City: Elmhurst State: NY VOCA HealthcareShift work
- RN - Utilization Review Shift: 5 Day Shifts X 8 Hrs Start Date: 09/21/2026 End Date: 11/14/2026 Duration: 8 Week(s) City: East Elmhurst State: NY TALENTShift workDay shift
$29 - $52 per hour
...services are delivered. As a Utilization Management Nurse at UnitedHealth Group,... ...require unrestricted compact RN licensure Function is responsible... ...includes Prior Authorization Review of skilled nursing facility,... ...Management experience (not case management) Proven basic computer...Remote jobHourly payMinimum wageFull timeWork experience placementLocal area- Position Summary: The RN Integrated Care Coordinator (UM) provides comprehensive... ...weekend hours are required to address utilization review cases. Roles and Responsibilities Prepares... ...reviews with emphasis on utilization management, discharge planning, care coordination...Live inRemote workFlexible hoursWeekday work
$88.85k
...income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Claims Review Nurse RN II is responsible for conducting clinical review of medical claims to ensure services were medically...Full time- ...Posting Title: Supervisor, Utilization Review Requisition Number: R-000003... ...Provides oversight of utilization management processes to support... ...monitors utilization review cases for accuracy, completeness,... ...progressive experience as an RN or in Utilization Review An...Full timePart timeWork experience placementReliefInternshipShift work
- Comagine Health seeks Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time, remote position requires Alabama licensure and focuses on compliant, cost-effective...Remote jobFull timeContract work
$79.3k - $127.1k
## Senior Case Manager RN (Remote)Apply: Remote: PA, Working at Home - Pennsylvania: Full time: Posted Today: J286849## **Company :**Highmark... ...services by detecting, resolving and preventing improper utilization of member benefits.**ESSENTIAL RESPONSIBILITIES*** Manage...SeniorRemote jobFull timeContract workWork at officeWork from home- ...Job Title: RN - Utilization Review (000298) Duties: 1 year of non-acute utilization review experience - required RN experience - preferred This is the pay range that RightSourcing (a part of Magnit) reasonably expects to pay someone for this position, however, as a supplier...
$2,398.55 per week
...: Seeking a dedicated Registered Nurse with experience in utilization review to evaluate patient records and ensure proper healthcare utilization... .... Qualifications: ~Hold a valid New York State RN License. ~Possess at least 1 year of non-acute utilization...- ## Lead RNApplylocations: Barnesville Hospital (BARNS... ...Functions as a primary lead RN. Performs balancing of... ...patient care outcomes, utilizing expert leadership skills... ...6. Supports, guides and reviews peer decision-making. Provides the Director/Manager/Clinical Preceptor with...Local areaShift work
- Volunteers of America Los Angeles is seeking a Senior Case Manager II to mentor the case management team and ensure services meet client needs. The role blends administrative duties with field outreach. You will assess client needs, develop service plans, coordinate referrals...Senior
$26.35 - $39.53 per hour
...Job Summary: The Concurrent Utilization Review (UR) Nurse is responsible for... ...provided to members under a managed care health plan. This role involves... ...leadership for complex cases, denials, and escalated reviews... ...Education: Registered Nurse (RN) or Licensed Vocational/...Hourly payWork at officeRemote work- AltaMed Health Services Corp. in Commerce, CA seeks an RN Case Manager & Care Coordinator Team Lead to oversee PACE participants in an ambulatory setting. The role focuses on coordinating nursing care and leading a multidisciplinary team to ensure high-quality, integrated...Senior
- ...direction of the Ambulatory Surgery Manager, coordinates and delivers care... ...in gastroenterology. Utilizes the nursing process to develop a plan of nursing care. The RN assumes responsibility for assessing... ...further information, please review the Know Your Rights notice...Full time
- ...Your Role The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced... ...Health Utilization Management Clinician, Senior, will report to the Manager of Behavioral Health...SeniorContract work
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