RN Utilization Review Specialist
University Medical Center, Inc.
UofL Health is seeking a Utilization Review RN in Louisville to support utilization management. The role includes admitting and concurrent reviews, interfacing with physicians and payors, and ensuring compliance with UM criteria and documentation standards. Ideal candidates hold an Associate’s degree in nursing, a KY RN license, and 2 years of RN experience with preference for case management experience and CCM/ ACM certification. #J-18808-Ljbffr University Medical Center, Inc.
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the RN Utilization Review Specialist in New York, NY vacancy
- ...facility in California is seeking experienced nursing professionals to review medical records and ensure appropriate admission status. The role... ...patient admissions. Candidates must have a valid California RN license and at least two years of clinical experience or a Master...SuggestedRemote work
Santa Barbara Cottage Hospital
New York, NY4 days ago $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...SuggestedGuidelight Health
New York, NY1 day ago$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 hours24-MAG LLC
New York, NY1 day ago$50k
...the 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...SuggestedRemote workAdvanced Recovery Systems LLC
New York, NY2 days ago- ...Coronis Health is seeking a remote Utilization Review Specialist to manage treatment authorization for behavioral health and substance abuse, interfacing with insurance and managed care entities. The role covers pre-certification, concurrent reviews, and appeals with a...SuggestedRemote work
Santa Barbara Cottage Hospital
New York, NY2 days ago - ...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...
Santa Barbara Cottage Hospital
New York, NY2 days ago - Concierge Home Care is seeking an experienced Utilization Review Specialist (RN) to join our remote home health team. This role emphasizes OASIS review, coding accuracy, QA, and remote documentation audits. The ideal candidate holds an active Florida RN license, OASIS certification...Remote job
- Netsmart is seeking a Registered Nurse with solid utilization management experience to perform ED utilization reviews and admissions screening using established criteria. The role requires adept EMR review, strong clinical judgment, and collaboration with ED physicians...Remote job
- ...Job Summary and Responsibilities As our Utilization Management Nurse, you will be a critical... ...utilization. Every day, you will meticulously review medical records, authorize services, and... ...outcomes. Collaborates with facility RN Care Coordinators to ensure progression of...
- ...delivering patient-centered care to each and every patient each and every day. Job Description Position Summary and Purpose The Utilization Review RN performs activities which support the Utilization Management functions. They are responsible for the delivery of the...Work at officeShift work
- ...and Responsibilities Responsible for the review of medical records for appropriate admission... ...reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical... ...in lieu of 1 year experience. California RN license. AHA BLS Ability to pass annual Inter...Remote work
- ...Responsibilities • Conduct telephonic clinical reviews • Complete PRI & Screen assessments •... ...Experience with Care Coordination, Utilization review and discharge planning Computer... ...or Masters in Nursing is required -RN Licensed as a Registered Nurse in the State...
RSC Healthcare Staffing
New York, NY11 days ago $30 - $38 per hour
A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Remote jobHourly payPart time$45 - $50 per hour
...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... ...nursing programs with an active New York RN license. #J-18808-Ljbffr kozmetickesluzby....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- University of Miami Health System seeks a full-time Utilization Review Case Manager to work remotely. The role reviews patient charts for prior authorization, concurrent and retrospective utilization, coordinating with the care team for timely and appropriate care. You...Remote jobFull time
- ...seeking an Appeals and Grievances Clinical Specialist to manage member complaints and... ...This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities... ...in clinical practice and knowledge of Utilization Review Guidelines. The position offers a...Remote work
Healthfirst
New York, NY8 hours ago $83k - $120k
...establish clear goals, and satisfy all regulatory requirements. Utilization Review & Triple-Check Coordination:Lead the weekly Utilization Review... ...: Licensure:Current, unrestricted Registered Nurse (RN) license in the state of practice. MDS Experience:1-3 years of...Full timeTemporary workPart timeWork at officeImmediate startFlexible hoursShift work$42 per hour
Registered Nurse (RN) - Telehealth Medicare Annual Wellness Visit Specialist - PRN Full-time WHO IS GUIDEHEALTH? Guidehealthis... ...are completed. Virtually reviewing and updating patient medical histories... ...factors for chronic diseases, utilizing remote monitoring tools when...Bi-weekly payFull timeTemporary workFor contractorsReliefLocal areaRemote workWork from homeMonday to Friday- Whitecap Search Healthcare Partners is seeking a dedicated RN for a Utilization Review & Quality Improvement role at a community hospital. This position focuses on utilization review responsibilities, working closely with physicians to analyze patient readiness for discharge...
- Molina Healthcare seeks a Registered Nurse with an Ohio or compact license to join the Care Review Clinician team. You will provide prior authorization for behavioral health services for the Ohio Medicaid population and bring strong behavioral health experience to a fast...
- CorroHealth, Inc. is seeking a part-time PRN Clinical Review Nurse (RN) to remotely review medical records for medical necessity, authorization compliance, and payer guideline alignment, supporting appeal submissions. You will perform clinical reviews, review inpatient...Remote jobPart timeRelief
- 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 jobFlexible hoursWeekend workDay shift
- Whitecap Search Healthcare Partners is seeking a dedicated RN for a Utilization Review & Quality Improvement role at a community hospital. This position focuses on utilization review responsibilities, working closely with physicians to analyze patient readiness for discharge...Hourly payRemote work
- ...seeking Nurses for a Monday-Friday role, 9:30 AM to 6:00 PM, with no nights, weekends, or holidays. The position emphasizes clinical reviews to determine if treatments meet criteria, with collaboration among case managers and disease management nurses. Qualified...Remote jobMonday to FridayWeekend workDay shift
- Brighton Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate with partners, and ensure timely, compliant documentation and communications with...Remote jobWork at office
- ...concurrent, retrospective, and Medicare reviews to determine medical necessity and support... ...and support concurrent and retrospective utilization reviews Identify quality concerns, report... ...Nurse (LPN) or Registered Nurse (RN) with a current, active state license required...
- Currently seeking a Utilization Management RN . Please see details and qualifications below: Position is remote - candidate must reside in the... ...evaluate members’ clinical conditions through medical record review to determine medical necessity for services. Using advanced...Immediate startRemote workDay shift
$26.01 - $56.14 per hour
...patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a vital role in ensuring members receive... ...Required Qualifications Active, unrestricted RN license in your state of residence with...Remote jobHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hoursShift work$35 - $45 per hour
...message the job poster from IntePros IntePros is seeking a Remote Utilization Review Nurse serves as a key clinical liaison, coordinating resources... ...Graduate of an accredited professional nursing program (RN, LPN, or LVN). Minimum of two years of general nursing experience...Contract workRemote workWeekend work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to RN Utilization Review Specialist. Be the first to apply!
