RN Utilization & Clinical Documentation Specialist
Self Regional Healthcare Inc.
Self Regional Healthcare in Greenwood, SC, is hiring an RN for utilization review/care coordination responsibilities. The position requires graduation from an accredited nursing program and SC RN licensure, with CPR within 1 month of employment. A BSN or higher is preferred, with 2+ years in utilization review or clinical documentation and knowledge of third party reimbursement. Experience in critical care, emergency, or surgical care is a plus. #J-18808-Ljbffr Self Regional Healthcare Inc.
- 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...SuggestedRemote jobFull timeContract work
- ...subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews... ...established guidelines. The role documents decisions and supports utilization review across multiple services.... ...associate degree, and 2+ years of clinical RN experience required. #J-18808-Ljbffr...SuggestedRemote jobFull time
$80k
...Base Salary for this role is $80,000 The CDI Specialist facilitates and obtains appropriate physician documentation for any patient clinical condition or procedure to support the... ...client experiences. Minimum Education Current RN Licensure Certifications: CRCR Required...SuggestedLocal areaRemote work- Confluence Health is seeking a clinically skilled professional to review and improve patient health records for accurate coding and reimbursement... ...with providers and coding teams to ensure high-quality documentation and patient outcomes. #J-18808-Ljbffr Confluence HealthSuggested
- ...in an environment that allows you to thrive both personally and professionally. Position Overview We are seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess the medical necessity and quality of healthcare services through prospective, concurrent...SuggestedFull timeContract workRemote work
- ...Blue Shield of Mississippi seeks an RN Medical Reviewer, FEP to perform thorough clinical reviews of Federal Employee Program pre... ...policy criteria, request necessary documentation, document decisions clearly, and monitor utilization trends for potential Care Management...
- Healthy Careers Start Here The RN Medical Reviewer, FEP is responsible for thorough clinical review of the Federal Employee... ...the necessary clinical documentation to make a determination. Once... ...identify member and provider utilization trends as well as identify members...Work at officeFlexible hours
- ...Performs medical reviews using clinical/medical information provided... ...sets or clinical guidelines. Documents decisions using indicated... ...review of medical claims and utilization practices. Logistics Palmetto... ..., You'll Need License Active RN licensure in state hired, OR,...Full timeFor contractorsWork experience placementLive inWork at officeLocal areaWork from homeHome officeMonday to FridayShift work
- ...Methodist Health System in Council Bluffs, IA is seeking a Clinical Documentation Specialist to ensure accurate representation of patient diagnoses and... ...staff while educating clinicians across teams. Required RN licensure with 5 years of clinical nursing experience; BSN...Full time
- ...Humana Inc. is seeking an Utilization Management Nurse 2 to apply clinical nursing skills in coordinating, documenting, and communicating medical services and benefit determinations. The role involves interpreting criteria, following guidelines, coordinating with providers...Remote work
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company... ...criteria to obtain, analyze, and accurately document clinical information from medical records in support of utilization...Bi-weekly payFull timeTemporary workFor contractorsLocal areaRemote workWork from home- ...POSITION SUMMARY: Performs clinically orientated medical chart reviews... ...of the medical center's utilization review plan, state and federal... ...Knowledge Condition 44 documentation and requirement; HINN notification... ...TEAM!! Utilization Review RN - Per Diem* *IMPORTANT NOTE:...Hourly payDaily paidWork experience placement
- ...Care Center of Augusta is seeking a dedicated, compassionate Utilization Review Nurse, RN to add to our growing team. Lighthouse Care Center of... ...residential treatment facility providing balanced, top-notch clinical care to children, adolescents and young adults. We provide...Work at officeLocal area
$110k
...time frame and with the most efficient utilization of resources. Carries out activities related... ...with physician regarding appropriate documentation for justification. Reviews the patient’s plan of care in conjunction with the clinical pathway, individualizing clinical...Daily 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 level of care for patients. The RN will review clinical documentation, apply established medical guidelines, and collaborate with...
$77.02k - $117.58k
...Top Workplaces. Summary The Utilization Review Nurse is responsible for... ...Review Nurse serves as a clinical resource in utilization management... ...Licensure: Registered Nurse (RN) Minimum Licensure (Other):... ...Ability to analyze clinical documentation and apply established criteria...Full timeWork at office- MarinHealth is seeking a Utilization Review Nurse II to perform admission, concurrent and retrospective reviews for designated health plans... ...and Electronic Health Records. In this role you will assess clinical stability, coordinate transfers for continued care, and...
- 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, at least 1...Hourly payDaily paid
$71.1k - $97.8k
Become a part of our caring community The Utilization Management Nurse 2 uses clinical nursing skills to support the coordination, documentation and communication of medical services or... ...Qualifications Licensed Registered Nurse (RN) in an Enhanced Nurse Licensure Compact (...Full timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday- 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...
- .... This full-time position coordinates home health, quality improvement, and utilization review for center patients, ensuring timely, appropriate care and documentation. The role requires MA RN licensure and a Bachelor’s degree in nursing; BLS is required. Experience in...Full time
- ...as needed). JOB SUMMARY The Utilization Review Nurse reviews medical... ...authorizations. The Utilization RN will also serve as the care... ...to their next phase of care. Documenting patient care and staying up... ...they align with established clinical guidelines, best practices, and...ReliefLocal areaRemote work
- Devoted Health is seeking a Clinical Guide Part A to support inpatient, behavioral health, and post-acute utilization review in alignment with CMS guidelines. This remote, full-time role requires a licensed RN with several years of UR experience and familiarity with Medicare...Remote jobFull time
- ...a licensed Registered Nurse to join our clinical team. Requirements include graduation from... ...an accredited school of nursing, Indiana RN licensure with current BLS, and at least... ...hospital clinical experience. Preferred: utilization review, case management, discharge planning...
- ...Description: Position Summary and Purpose The Utilization Review RN performs activities which support the... ...including but not limited to making clinical recommendations regarding medical... ...by utilizing the current MCG criteria; documents clinical information in Case...Work at officeShift work
- Sisters of Charity Hospital in Buffalo, NY seeks a Registered Nurse, Utilization Review, to join the middle revenue cycle and interdisciplinary... ...manage third-party payer relationships and inquiries. BSN or RN with a BS, NYS RN license, CCM certification within one year,...
$78k - $96.2k
...Job Title: Clinical Documentation Specialist Department: Clinical Documentation Improvement Location: Unity... .... For Skilled Nursing Facility Only: Utilize the ICD-10-CM Official Guidelines for... ...6, will consider active unrestricted RN candidates (or other clinicians as defined...Full timeTemporary workRemote workMonday to FridayShift work$32.5 - $44 per hour
...seeking a compassionate and skilled Clinical Documentation Specialist to join our dedicated care team. This... ...diagnoses for inpatients/residents. The CDS utilizes the hospital's designated clinical... .... Currently holds an unencumbered RN license with the State Board of Nursing...Full timePart timeWork experience placementWork at officeRemote workWork from homeShift workDay shift- ...Position Title: Clinical Documentation Specialist Department: Clinical Document Improvement Job Description... ...year of relevant clinical, coding, utilization review, or healthcare documentation... ...information credential required (e.g., RN, LPN, Physician's Assistant, Nurse...Full timeRemote work
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