RN - Utilization Review
TALENT
RN - Utilization Review
Shift: 5 Day Shifts X 8 Hrs
Start Date: 09/21/2026
End Date: 11/14/2026
Duration: 8 Week(s)
City: East Elmhurst
State: NY
TALENTVacancy posted 11 hours ago
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...outcomes in the expected time frame and with the most efficient utilization of resources. Carries out activities related to utilization... ...physician regarding appropriate documentation for justification. Reviews the patient’s plan of care in conjunction with the clinical...Daily paidFull timePart timeFlexible hoursShift workMontefiore Nyack
Brooklyn, NY22 hours ago- 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
- Palmetto GBA is seeking an experienced RN for remote utilization review to evaluate medical claims using established criteria and guidelines. The role emphasizes timely decisions, documentation, and collaboration with internal teams. You will work from a home office and...Remote jobWork from homeHome office
- ...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
- ...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
- ...Summary: Seeking an experienced Registered Nurse specializing in utilization review to assess non-acute cases. This role involves evaluating... ...utilization. Qualifications: Possess a valid New York State RN license. Have at least 1 year of non-acute utilization...
TactStaff
East Elmhurst, NY3 days ago - Sentara Health Plans Community Care in Norfolk, VA seeks an Utilization Review Nurse to manage utilization management within licensure. You will... ...decisions to members and providers. The role requires a RN license, 3 years of acute care experience, and familiarity with...
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...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- ...at hospitals and physician practices throughout downstate New York. Job Description Reviews and coordinates prospective, concurrent and retrospective activities related to utilization. Monitors documentations for accuracy and clinical compliance. Organizes and coordinates...Night shift
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- ...Performs clinically orientated medical chart reviews and other administrative tasks to meet the requirements of the medical center's utilization review plan, state and federal... ...WELCOMING YOU TO OUR TEAM!! Utilization Review RN - Per Diem* *IMPORTANT NOTE: In lieu of...Hourly payDaily paidWork experience placement
- Optum is seeking a Utilization Review Nurse (RN) to perform inpatient utilization management, applying evidence-based guidelines to admissions and preauthorization requests. The role requires clinical judgment, documentation in the care management system, and collaboration...Remote jobMonday to FridayWeekend work
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Optum is a global healthcare organization empowering care through technology. The Utilization Management Nurse role involves reviewing medical records, extracting case details, and crafting defensible appeal letters according to process instructions and guidelines. The...Remote jobFull timeMonday to Friday- 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...
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...income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Claims Review Nurse RN II is responsible for conducting clinical review of medical claims to ensure services were medically...Full time- 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...
- ...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...
- 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
- 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...
- ...detail-oriented Registered Professional Nurse III to support our Utilization Review and Appeals functions. This role is responsible for evaluating... ...preferred. Licensure: Current, valid Registered Nurse (RN) license in the State of Hawaiʻi. Preferred Skills & Attributes...Full timeShift workWeekend work
- INTEGRIS Baptist Medical Center in Oklahoma City, OK is seeking a day shift/variable, full-time RN Case Manager - Utilization Review. You will assess patients, coordinate transfers, and develop discharge plans to optimize resources and patient outcomes. Qualifications...Full timeDay shift
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