Utilization Review Nurse
UnitedHealth Group
UnitedHealth Group is seeking a Utilization Review Nurse, RN to perform inpatient utilization management in California. The role involves reviewing inpatient criteria, preauthorizations, and ensuring medical necessity while applying evidence-based guidelines.
In addition to clinical duties, you will document decisions and collaborate with Medical Directors for complex cases. The position may offer remote work options and requires working a Monday–Friday schedule with weekend rotation.
#J-18808-Ljbffr- ...Contract (Possibility of Extension) Position Overview We are seeking an experienced Utilization Management (UM) Registered Nurse to support outpatient utilization review and prior authorization activities for a leading healthcare organization. The ideal candidate...SuggestedContract workRemote work
- ...who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage... ...Employee Referral Bonus Program JOB SUMMARY: The Utilization Review Nurse is to assess the medical necessity and quality of healthcare...SuggestedFull timeTemporary workLocal areaRemote work
- ...Utilization Review Nurse Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Utilization Review Nurse, you'll play an important role in helping us offer customized, self-funded insurance options to our clients...SuggestedFull timeTemporary workSummer workWork at officeRemote workFlexible hours
- ...Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to... ...patient from admission to discharge and provide the physician and nursing staff with the best possible options for post hospital care...SuggestedWork at officeShift work
- A Director for Cyber Security position is now available through Adecco Healthcare and Life Science. In this position, you will be responsible for reporting reports to the Chief Information Security Officer (CISO) and oversees cybersecurity operations and strategy. This...SuggestedTemporary workWork experience placementFor subcontractorWork at officeLocal areaRelocation package
$65.86 - $76.15 per hour
...Utilization Review Nurse III - Washington StatePrimary Location Renton, Washington Employee Status: Regular Schedule Full-time Scheduled Weekly Hours: 40 Shift Day Salary $65.86 - $76.15 / hour Job Number 1443591 Worker Location: FlexibleUtilization Review Nurse III -...Full timeWork experience placementLive inLocal areaWork from homeFlexible hoursShift work$78k - $88k
...company that values work-life balance, continuous learning, and career development. Summary We are seeking a skilled Utilization Review Nurse to conduct prior authorization, prospective, concurrent, and retrospective reviews for medical necessity and...Full timeContract workWork at officeRemote workWork from homeFlexible hours- ...Job Description A facility located near Lexington, Nebraska is seeking a Utilization Review Registered Nurse to join their team! Utilization Review Registered Nurse Opportunity: Full-time, permanent position Schedule: Monday-Friday, 9:00AM-5:00PM...Permanent employmentFull timeMonday to Friday
- ...Native/Indian Preference/EEO Employer Start Over with Job Search RETURNING APPLICANT? Login Now Utilization Review Nurse Job Code: 2026:OTZ-201 Location: Kotzebue, Alaska Program: Nursing Division FT/PT Status: Full Time Job Responsibilities:...Full timeContract workWork at office
- ...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...
$42 - $65 per hour
...Job Description Job Description Utilization Review Nurse Location: Las Vegas, NV Job Type: Full-Time Pay: $42–$65/hr + Sign-On Bonus Job Summary Review patient admissions and continued stays to ensure medical necessity, appropriate resource utilization...Full timeRelocation package$40 - $63 per hour
...Utilization Review Nurse (RN) Las Vegas, NV | Full-Time Salary: $40 – $63/hour Position Summary Reviews patient admissions for medical necessity, appropriate resource utilization, and compliance with payer guidelines. Analyzes medical records to ensure care meets established...Full timeWork at officeShift workWeekend work- ...Telenett is seeking a Remote Utilization Review Nurse to review medical records from a home office and determine medical necessity and care appropriateness. You will work with providers to develop compliant care plans and ensure high-quality, cost-efficient services for...Remote workHome office
- ...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
- ...Responsibilities Lighthouse Care Center of Augusta is seeking a dedicated, compassionate Utilization Review Nurse to add to our growing team. Lighthouse Care Center of Augusta (LCCA) is a multi-discipline behavioral healthcare center that offers mental health services...Work at officeLocal area
$43 - $63 per hour
...Job Description Job Description The Utilization Review Nurse plays a key role in evaluating patient admissions to ensure appropriate levels of care, efficient resource utilization, and compliance with third-party payer requirements. This position involves reviewing...Relocation package- ...Moffitt Cancer Center in Tampa, FL seeks an Utilization Review Nurse to perform initial, concurrent, and retrospective reviews ensuring medical necessity and appropriate care levels. You will collaborate with case management, physician advisers, providers, and payers...
$20 - $36 per hour
...Utilization Review Lvn Nurse Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a...Hourly payMinimum wageFull timeWork experience placementWork at officeLocal area$80 - $95 per hour
...Hospital RN – Care Coordination & Utilization ReviewImmediate need for a talented Hospital RN – Care Coordination & Utilization Review. This is a 06+months contract opportunity with long-term potential and is located in San Jose, CA (Onsite). Please review the job description...Contract workLocal areaImmediate start$35 - $43 per hour
...Base pay range $35.00/hr - $43.00/hr Job Title Clinical Review Nurse – Concurrent Review Location: Remote (California only – must reside... ...The Clinical Review Nurse – Concurrent Review will perform utilization management functions to ensure members receive the right care...Remote work- ...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
- A leading healthcare recruiting firm in Indianapolis is seeking an experienced RN to ensure high-quality care and manage medical necessity for services. The role requires a clear RN license in Indiana, 2 years of acute care experience, and strong computer skills. You will...
$40 per hour
...responsible for performing initial, concurrent review activities; discharge care coordination... .... Provides information regarding utilization management requirements and operational... ...members, providers and facilities. Registered Nurse (RN) with valid, current, unrestricted...Contract workWork at officeRemote work$53.76k
...Trainee 1 ($53,764): Four years of experience conducting financial reviews and evaluations, determining payment sources, and developing... ...all employees' unique attributes and skills are valued and utilized to support the mission of the Agency. OMH is an equal opportunity...Permanent employmentTraineeshipWork at officeRemote workFlexible hours$30.64 - $45.8 per hour
...The 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 supporting the goals...Hourly payMinimum wageFull timeWork at officeLocal areaRemote workFlexible hours- ...appropriateness of hospital admission, utilization of resources and medical necessity for continued... ...as they relate to utilization review and discharge planning and payer regulations... ...Graduate of an accredited professional nursing school ~ Current Massachusetts Nursing...
$34 - $40 per hour
.../hr - $40.00/hr Remote (Compact Licensure Required) - Open to LPN's & RN's About the Role Medix is seeking an experienced Utilization Review Nurse to support our mission of improving patient care through home-based health services. In this role, you will coordinate and...Full timeRemote work- ...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
- ...iMPROve Health seeks an RN Reviewer (Workers' Compensation Utilization Review) to perform independent external medical reviews remotely as an independent contractor (1099). The reviewer applies clinical expertise to evaluate cases, ensuring medical necessity and standard...For contractorsRemote work
- ...Role: Utilization Review Nurse RN Responsibilities: Conducts concurrent and retrospective reviews to ensure appropriate care levels, medical necessity, and compliance. Collaborates with physicians, care managers, and payers to secure authorizations, prevent denials, and...
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