Utilization Review RN — Behavioral Health
Universal Hospital Services Inc.
Lighthouse Care Center of Augusta is seeking a dedicated Utilization Review Nurse, RN to join our behavioral health team in Augusta, GA. Under the Director of Utilization Management, you will review clinical content of medical records and support pre-certifications and continued authorizations. You will collaborate with physicians, therapists, nurses and staff, enter data into the Midas system, coordinate with treatment teams, verify insurance coverage, and help ensure timely reviews. #J-18808-Ljbffr Universal Hospital Services Inc.
- Molina Healthcare is seeking a PMHNP for behavioral health utilization reviews in Florida. This role requires applying evidence-based criteria, reviewing medical records, and collaborating with physicians to ensure clinically appropriate, cost-effective care. The candidate...Suggested
- ...Augusta is seeking a dedicated, compassionate Utilization Review Nurse, RN to add to our growing team. Lighthouse Care Center... ...of Augusta (LCCA) is a multi-discipline behavioral healthcare center that offers mental health services to the communities of surrounding Augusta...SuggestedWork at officeLocal area
- ...) Job Description Summary: About UofL Health: UofL Health is a fully integrated regional... ...: Position Summary and Purpose The Utilization Review RN performs activities which support the... ...) 1 Three years’ experience with Behavior Health experience (required for positions...SuggestedWork at officeShift work
- ...clinically orientated medical chart reviews and other administrative tasks... ...of the medical center's utilization review plan, state and federal... ...ancillary staff. CARSON VALLEY HEALTH IS PROUD TO BE RECOGNIZED AS A... ...OUR TEAM!! Utilization Review RN - Per Diem* *IMPORTANT NOTE:...SuggestedHourly payDaily paidWork experience placement
$110k
...Summary Comprehensively plans with the health care team to ensure patient needs are met... ...time frame and with the most efficient utilization of resources. Carries out activities related... ...documentation for justification. Reviews the patient’s plan of care in conjunction...SuggestedDaily paidFull timePart timeFlexible hoursShift work- 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
- ...Summary We are seeking an experienced Registered Nurse (RN) - Utilization Review to evaluate the medical necessity, appropriateness, and... ...guidelines, and collaborate with physicians, case managers, health plans, and other healthcare professionals to ensure...
- MarinHealth is seeking a Utilization Review Nurse II to perform admission, concurrent and retrospective reviews for designated health plans in a 40-hour week on days at Greenbrae, CA. The role requires a BSN preferred, 3+ years of acute care experience, and experience...
- Carson Valley Health in Nevada seeks a Per Diem Utilization Review RN to perform clinically oriented medical chart reviews and support the hospital's utilization review plan, ensuring medical necessity and proper documentation. Requirements include Nevada RN licensure,...Hourly payDaily paid
$71.1k - $97.8k
...part of our caring community The Utilization Management Nurse 2 uses clinical... ...Licensed Registered Nurse (RN) in an Enhanced Nurse Licensure... ...in prior authorization, claims review, utilization management, or other healthcare/health insurance environments involving...Full timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday$77.02k - $117.58k
...named one of the Tampa Bay Times’ Top Workplaces. Summary The Utilization Review Nurse is responsible for performing initial, concurrent, and retrospective... ...Needed: Yes Minimum Licensure: Registered Nurse (RN) Minimum Licensure (Other): Knowledge of utilization management...Full timeWork at office- ...Requirements include graduation from an accredited school of nursing, Indiana RN licensure with current BLS, and at least two years of hospital clinical experience. Preferred: utilization review, case management, discharge planning, DRGs, or CMS Swing Bed experience. We...
- ...of Charity Hospital in Buffalo, NY seeks a Registered Nurse, Utilization Review, to join the middle revenue cycle and interdisciplinary care team... ...manage third-party payer relationships and inquiries. BSN or RN with a BS, NYS RN license, CCM certification within one year,...
- Hilo Benioff Medical Center is seeking an experienced Registered Nurse IV to join our Utilization Review team. This role ensures medical necessity and appropriate level of care while supporting reimbursement through clinical reviews. The ideal candidate brings strong clinical...
- Overview USA Health is Transforming Medicine along the Gulf Coast to... ..., to include: quality reviews, prior authorizations, initial... ...appropriate implementation of Utilization Review functions Communicates... ...Review experience Preferred RN - Registered Nurse - State Licensure...Live in
- University of South Alabama Health System seeks an experienced Registered Nurse for Utilization Review to perform quality reviews, prior authorizations, and discharge planning... ...-party payors. The position requires an Alabama RN license, with a Bachelor's degree in Nursing...
- ...Partners, Inc. leads the case management team with a strong focus on utilization review, ensuring compliant care and reducing unnecessary hospital... ...optimize care coordination and outcomes. Requirements include RN license with BSN, UR/UR-related credentials, and 3+ years...
- Sentara Health Plans Community Care in Norfolk, VA seeks an Utilization Review Nurse to manage utilization management within licensure. You will handle prior authorization... ...to members and providers. The role requires a RN license, 3 years of acute care experience, and familiarity...
$88.85k
....) -$142,166.00(Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state... ...required to achieve that purpose. Job Summary The Utilization Management (UM) Claims Review Nurse RN II is responsible for conducting clinical review of...Full time- ...way we work through improvement huddles, employee surveys, and town hall meetings Job Description A Day In The Life The Utilization Review Specialist (RN) is responsible for ensuring appropriate utilization of healthcare services across the continuum of care. This role...Work at officeWeekend work
- Position Summary: The RN Integrated Care Coordinator (UM) provides comprehensive care... ...Team and the overall experience of Evry Health’s members. The incumbent strives to... ...Rotating weekend hours are required to address utilization review cases. Roles and Responsibilities...Live inRemote workFlexible hoursWeekday work
- Beyond Blue is seeking a Supervisor, Utilization Review to lead the daily operations of the utilization review team in the UK. The role ensures compliance with payer guidelines and regulatory standards while guiding staff performance and quality assurance. Responsibilities...
- 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
- Comagine Health in Alabama is seeking Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective utilization reviews. This is a full-time remote role supporting Alabama contracts. You will apply...Remote jobFull time
- ...BlueCross BlueShield South Carolina subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews and determine medical... ...established guidelines. The role documents decisions and supports utilization review across multiple services. The position is remote,...Remote jobFull time
- Nexus Health Systems is seeking a Clinical Reviewer to support the evaluation and admission of patients in our behavioral health, neurodevelopmental, and medically complex programs. The role requires RN or NP credentials with strong documentation and clinical judgment,...
- ...Available! *** Banner Health invests in our nurses by... ...Bedside Registered Nurses (RN) can grow within the... .... Unit Overview The Behavioral Health Pavilion at the... ...have the opportunity to utilize our self-scheduling tool... ...discharge planning needs. Reviews patient history and...Full timeTemporary workInterim roleShift workWeekend workDay shift
- # Behavioral Health RN27 N Vann St, Pryor, OK 74361June 16, 2026Full TimePart TimeApply Now**Deadline... ...-day SNVs and OASIS within 48 hours* Utilize appropriate behavioral health and... ..., including responding to QA and coder reviews and performing clinical record audits*...
- ...Oklahoma City, OK is seeking a day shift/variable, full-time RN Case Manager - Utilization Review. You will assess patients, coordinate transfers, and... ...of CMS and payer requirements is essential. INTEGRIS Health offers a supportive mission-driven environment. #J-1880...Full timeDay shift
- ...Moffitt Cancer Center in Tampa, FL seeks an Utilization Review Nurse to perform initial, concurrent, and retrospective reviews ensuring medical... ...Minimum education includes an Associate's Degree in Nursing with RN licensure; a Bachelor's in Nursing is preferred. #J-18808-...
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