RN Utilization Review & Care Coordination
CH and Trinity, P.C.
Sisters of Charity Hospital in Buffalo, NY seeks a Registered Nurse, Utilization Review, to join the middle revenue cycle and interdisciplinary care team, delivering comprehensive UR in the hospital. The UR nurse collaborates with the care team to maintain appropriate levels of care, remove barriers to treatment, and manage third-party payer relationships and inquiries. BSN or RN with a BS, NYS RN license, CCM certification within one year, and UR criteria knowledge are preferred. #J-18808-Ljbffr CH and Trinity, P.C.
- MarinHealth is seeking a Utilization Review Nurse II to perform admission, concurrent and retrospective... ...a BSN preferred, 3+ years of acute care experience, and experience with case... ...role you will assess clinical stability, coordinate transfers for continued care, and...Suggested
- ...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...Suggested
$110k
...Nyack, New York Department: Care Management Work Shift: Day Work... ...are met and care delivery is coordinated across the continuum.... ...and with the most efficient utilization of resources. Carries out activities... ...documentation for justification. Reviews the patient’s plan of care in...SuggestedDaily paidFull timePart timeFlexible hoursShift work- ...Registered Nurse to join the Primary Care Team in Worcester, MA. This full-time position coordinates home health, quality improvement, and utilization review for center patients, ensuring timely... ...documentation. The role requires MA RN licensure and a Bachelor’s degree in...SuggestedFull time
- ...pharmacists and other highly skilled health care professionals—UofL Health is focused... ...: Position Summary and Purpose The Utilization Review RN performs activities which support the... ...in the most appropriate level of care; coordinates care in conjunction with other members...SuggestedWork at officeShift work
- ...case management team with a strong focus on utilization review, ensuring compliant care and reducing unnecessary hospital stays.... ...collaborates across departments to optimize care coordination and outcomes. Requirements include RN license with BSN, UR/UR-related credentials...
- ...our team as a day shift/variable, full time, RN Case Manager - Utilization Review, at INTEGRIS Baptist Medical Center,... ...utilizing all available resources. Recommends and coordinates timely transfers to appropriate levels of care as indicated by clinical needs and...Full timeWork at officeDay shift
- Beyond Blue is seeking a Supervisor, Utilization Review to lead the daily operations of the utilization... ...assurance. Responsibilities include coordinating with physicians, payers, and interdisciplinary teams to optimize patient care and reimbursement, delivering timely authorization...
- Optum is seeking a Utilization Review Nurse (RN) to perform inpatient utilization management, applying evidence-based guidelines to determine medical... ...role requires strong clinical judgment, documentation in care management systems, and collaboration with physician leadership...Remote workWeekend work
- ...clinically orientated medical chart reviews and other administrative tasks... ...of the medical center's utilization review plan, state and federal... ...; three (3) years of clinical care or nursing experience; OR an equivalent... ...OUR TEAM!! Utilization Review RN - Per Diem* *IMPORTANT NOTE:...Hourly payDaily paidWork experience placement
- ...Job 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...
- ...Overview: Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse. The Utilization Review... ...Conducts pre-certification, care coordination for appropriateness of treatment,... ...Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning...Temporary workRemote workShift work
- ...seeks an experienced Registered Nurse for Utilization Review to perform quality reviews, prior... ...The role collaborates with physicians and care teams to ensure compliant, timely patient... ...payors. The position requires an Alabama RN license, with a Bachelor's degree in Nursing...
$66.83k - $111.38k
...Wisconsin, Wyoming. Job Responsibilities Utilization Review Nurse is responsible for utilizing... ...certification, continued stay review, care coordination, or discharge planning for appropriateness... .../Licensure: Registered Nurse (RN) License (Compact or Virginia) REQUIRED...Permanent employmentFull timeTemporary workRemote workShift workDay shift- L.A. Care Health Plan in Los Angeles, CA is seeking a Utilization Management (UM) Claims Review Nurse RN II to evaluate medical claims for medical necessity, documentation, and proper coding. This role supports payment integrity through pre-payment and retrospective reviews...
$60.2k - $107.4k
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$77.02k - $117.58k
...Bay Times’ Top Workplaces. Summary The Utilization Review Nurse is responsible for performing initial... ...medical necessity, appropriate level of care, and continued stay in accordance with... ...Yes Minimum Licensure: Registered Nurse (RN) Minimum Licensure (Other): Knowledge of...Full timeWork at office$88.85k
...0(Mid.) -$142,166.00(Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by... ...required to achieve that purpose. Job Summary The Utilization Management (UM) Claims Review Nurse RN II is responsible for conducting clinical review of medical...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...
- Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective... ...issues and participates in coordination of individualized patient care services. The Utilization Reviewer... ...Registration/Licensure: Current US state RN license with authorization to...Work at officeShift work
- 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...Remote jobFull time
- ...RN - Utilization Review Number of Positions: 1 Remaining Positions: 1 Duties: 1 year of non-acute utilization review experience - required RN experience - preferred This is the pay range that RightSourcing (a part of Magnit) reasonably expects to pay someone for...
$55 - $65 per hour
...Registered Nurse With Utilization Review ExperienceA healthcare organization is seeking a Registered Nurse with utilization review experience... ...in the Queens, NY area and requires an active New York State RN license. The ideal candidate will have experience reviewing healthcare...Hourly payContract work- ...RN - Utilization ReviewNumber of Positions: 1Remaining Positions: 1Duties: 1 year of non-acute utilization review experience - required RN experience - preferred This is the pay range that RightSourcing (a part of Magnit) reasonably expects to pay someone for this position...
- 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
- 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
- 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 TALENTShift workDay shift
- ...assigned authorizations for participant care, supplies, and other related needs. This... ...discharge date, diagnosis, discharge location). Coordinate authorization information for all... ...care environment, preferably in a utilization related role. Must have one year of experience...Work at office
$81.51k - $108.03k
...yr - $108,030 / yr Overview RN – MDS Coordinator Turn Clinical Expertise Into... ...Outcomes. Shape Individualized Care. Make an Impact at West... ...incomplete or untimely information. Review resident records, incidents,... ...reflect current needs. Utilize clinical judgment and...Temporary workWork at officeLocal areaShift work
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