Post-Acute Utilization Review Clinician
WellSky Administrative Services Corporation
WellSky Administrative Services Corporation in the United States is seeking an experienced Utilization Review Clinician to review medical records and determine medical necessity for post-acute services, coordinate with physicians and case managers, and ensure timely follow-ups. The role requires a BS or equivalent, 4–6 years clinical nursing or therapy, active RN/OT/PT license, and comfort with decision support tools and MS Office. #J-18808-Ljbffr WellSky Administrative Services Corporation
- ...Technologies, Inc. is seeking a Registered Nurse with utilization management experience to review ED admissions and apply InterQual/MCG criteria for medical... ...EMR-based workflows. Ideal candidates have 3+ years in acute care nursing and 2+ years in utilization management,...SuggestedRemote job
- ...10pm Central (2pm to 11pm Eastern). The Utilization Review Clinician is responsible for reviewing medical records... ...visits, and ensuring timely post-discharge follow-ups with completed assessments to help prevent acute care readmissions. In this role, you will...SuggestedRemote jobFull timeWork experience placementWork at officeWorldwideMonday to FridayShift work
$27.02 - $48.55 per hour
...Position Purpose: Performs a clinical review and assesses care related to mental health... ...data to improve quality and appropriate utilization of services Provides education to providers... .... Master’s degree for behavioral health clinicians required. Clinical knowledge and ability...SuggestedHourly payWork at officeRemote work10 hours per weekFlexible hoursShift workWeekend workWeekday work$63k - $94k
...Remote Utilization Review Registered Nurse (UR RN) Are you an experienced RN looking to transition away from the bedside while still making... ...Experience: At least 3 years of nursing experience in an acute care environment is strongly preferred. Previous experience in...SuggestedWork at officeRemote work10 hours per weekFlexible hoursShift workWeekend workAfternoon shift3 days per week- Centene Corporation is seeking a fully remote Behavioral Health Utilization Review Specialist. The role focuses on evaluating mental health and substance use care, performing prior-authorizations, and conducting concurrent reviews to ensure medically appropriate levels...SuggestedRemote job
- Centene Corporation seeks a Behavioral Health Utilization Review professional to perform clinical reviews and assess the appropriateness of mental health and substance use services. This fully remote role supports Ambetter / Marketplace, reviewing requests for inpatient...Remote job
$2,300 - $2,500 per week
...RN - Utilization Review Location: New York, NY 10004 Contract: 13 weeks Schedule: 3 Days/Week | 11.5 Hours/Day Shift Time: 9:0... ...New York, NY. The ideal candidate will have experience in non-acute utilization review , along with strong community nursing and...Hourly payContract workLocal areaWork from homeShift work3 days per week$63.1k - $94.65k
...all applications and next steps. Our partner is looking for a Utilization Review RN based in the United States. Join a healthcare team... ...Clinical experience: Three years of nursing experience in an acute care setting is preferred. Utilization review expertise: Previous...Temporary workPart timeWork at officeRemote workFlexible hoursShift workAfternoon shift- Community Care is seeking a Registered Nurse to perform utilization review and coordinate care for members across the health care continuum... ...outcomes. In this role, you will review outpatient, inpatient, and post-acute services, communicate findings to providers, and participate...
$100 per hour
Seeking an experienced Registered Nurse for an 8-week travel assignment in Utilization Review. This role is ideal for an RN with experience in clinical investigations, medical record reviews, and non-acute utilization review. Position Details Specialty: Utilization Review...Monday to Friday- ...members based on authorization and concurrent review. Provides monthly telephonic outreach to... ...appropriateness of treatment setting by utilizing the applicable medical policy and... ...an AS/BS in Nursing At least 2 years of acute care clinical experience; or any combination...Contract workRemote workMonday to FridayFlexible hours
$2,507 per week
...Registered Nurse (RN) | Utilization Review Location: New York, NY Agency: Infojini Healthcare Pay: $2,507 per week Shift Information: 3 days x 11 hours Contract Duration: 8 Weeks Start Date: 10/26/2026 About the Position TravelNurseSource...Daily paidPermanent employmentFull timeContract workTemporary workImmediate startFlexible hoursShift work$2,507 per week
...Registered Nurse (RN) | Utilization Review Location: New York, NY Agency: Infojini Healthcare Pay: $2,507 per week Shift Information: 3 days x 11 hours Contract Duration: 8 Weeks Start Date: 10/26/2026 About the Position RN - Utilization...Full timeContract workShift work$57.24k - $62.18k
...setting ROLE DESCRIPTION: This individual will utilize clinical knowledge and communication... ...will defer decision to a second level reviewer. This individual interfaces with case managers... ...program. Minimum of 3 years recent acute clinical practice required, 5 years preferred...Temporary workWork at officeRemote workMonday to FridayFlexible hours- ...Description Responsibilities Review and evaluate electronic medical... ...to assess and ensure proper utilization of healthcare resources Participate... ...years clinical experience in acute care setting in emergency room... ...to Netsmart policy, all post-offer candidates are required...For contractorsReliefWork at officeRemote work
- HonorHealth in Phoenix is seeking an Utilization Review RN Specialist to review and monitor utilization, ensuring medically necessary care and... ...1 year UR/UM or Case Management experience and 3 years RN in acute care, with strong collaboration across disciplines and payer...Remote job
$35 - $45.94 per hour
Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team. About... ...least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)... ...states for this role are listed in the job posting. Voluntary Self-Identification For...Hourly payFull timeFor contractorsRemote workWork from homeRelocationHome officeWeekend work- Currently seeking a Utilization Management RN . Please see details and qualifications below:... ...Medical/Surgical experience. ** Previous Acute Hospital Utilization Management and... ...clinical conditions through medical record review to determine medical necessity for services...Immediate startRemote workDay shift
- ...better care experience for all. Job Summary: The Concurrent Utilization Review (UR) Nurse is responsible for conducting real-time clinical... ...Assist in transitioning patients from inpatient to outpatient or post-acute care settings. 5. Compliance & Documentation Ensure...
- ...Centene Corporation seeks a remote Behavioral Health reviewer to support the Texas Ambetter Inpatient Behavioral Health population. The role requires 4 x 10-hour shifts weekly with Saturday availability; weekend differential is offered. You will evaluate care, perform...Remote workShift workWeekend work
$2,507 per month
...Central office Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 19239171 Job Title RN - Utilization Review (000298) Weekly Pay $2507.0 Shift Details...Weekly payWork at officeShift work- ...RN – Utilization Review We are seeking a Utilization Review Registered Nurse (RN) to review patient records and determine the appropriateness and medical necessity of healthcare services. The RN will evaluate clinical information, support efficient resource use, and...
- Pyramid Consulting is seeking a Clinical Review Nurse for a 06+ month remote contract in the United States. The role focuses... ...nursing program, RN licensure, and 2-4 years in acute care with utilization management experience preferred. Benefits include comprehensive...Remote jobContract work
$63k - $65k
...® Fortune Best Workplaces in Financial Services & Insurance Utilization Review RN As a nurse at Sedgwick, you can build a meaningful and rewarding... ...be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of...Work experience placementRemote workFlexible hours$21.6 - $46.81 per hour
...Healthcare is hiring for a Care Review Clinician (RN or LPN). This role is... ...care model. Adheres to utilization management (UM) policies and... ...including experience in hospital acute care, inpatient review,... ...39012 Job Category Clinical Posting Date 10/08/2026, 09:44 PM Job...Remote jobHourly payFull timeContract workWork experience placementWork at officeMonday to Friday- Comagine Health is seeking a remote clinical reviewer to support behavioral health services across Oregon. You will evaluate documentation for medical necessity, conduct functional needs assessments, and coordinate home and community-based care. You will manage referrals...Remote jobWork from home
- Centene is seeking a remote Behavioral Health Review clinician with licensed credentials to assess and authorize mental health and substance use services. You will collaborate with providers and medical directors to ensure appropriate levels of care and discharge planning...Remote job
- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant patient care. The role emphasizes adherence to HIPAA, state and federal regulations, and a strong team-oriented environment...Work at officeRemote work
$50 - $55 per hour
...RN – Utilization Management Read on to find out what you will need to succeed in this position, including skills, qualifications, and... ...Strong payer-side UM experience, including medical necessity reviews, prior authorizations, appeals, and benefit determinations ~...Permanent employmentTemporary workMonday to Friday$85k - $95k
...Responsibilities and Duties: Conduct concurrent, retrospective, and pre-admission reviews to determine medical necessity and level of care. Evaluate clinical documentation to ensure appropriate utilization of services according to established criteria (e.g., InterQual, MCG)....Shift work
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