Nurse, Utilization Review - Workers’ Comp Specialist
Tristar Risk Management
Tristar Risk Management is seeking an experienced nurse to perform Workers’ Compensation utilization review across prospective, concurrent, expedited, and retrospective cases. The role includes discharge planning and coordination with Case Management for ongoing patient needs. Responsibilities cover reviewing treatment requests per guidelines, ensuring timely, compliant reviews, and collaborating with Medical Director on safety issues while promoting cost-effective care. #J-18808-Ljbffr Tristar Risk Management
$69.39k - $88.61k
...Cincinnati Children’s is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports case management, authorization, compliance, and education within the Utilization Review department. The role requires a Bachelor...SuggestedFull timeRemote work- WNS HealthHelp (A Capgemini Company) is seeking a licensed registered nurse to perform concurrent inpatient utilization reviews from a remote setting. You will collaborate with attending physicians and care teams to determine medical necessity and appropriate level of care...SuggestedRemote job
- Quorum Health Corporate is seeking a remote Utilization Review Specialist with a registered nurse background to manage admission decisions and concurrent reviews, ensuring compliance with payer and regulatory standards. Responsibilities include coordinating appeals, documenting...SuggestedRemote job
- ...The Utilization Review Specialist's primary role is the liaison between the hospitals inpatient and ambulatory services and the managed care organizations. The UR specialist is responsible for a wide range of administrative responsibilities including obtaining authorization...Suggested
- ...FHE Health in the United States seeks an experienced Utilization Review Specialist to manage clinical authorization processes, ensuring timely, accurate, and compliant communications with insurance payers. You will support patient access by securing initial and continued...SuggestedRemote work
- ...The Arizona Health Care Cost Containment System (AHCCCS) is seeking a Behavioral Health Prior Authorization Utilization Review Consultant. The role focuses on monitoring, evaluating, and approving or denying payment for medical and behavioral health services for the Fee...Remote work
$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...- ...Looking For We are seeking an experienced specialist who is passionate about making a... ...from accredited college or university in Nursing, Social Work, Behavioral Health or... ...field required preferred. 2-3 years of utilization review experience in behavioral health, addiction...Daily paidFull timeRemote work
- ...Gosnold is seeking an Utilization Review Specialist to perform pre-certification and concurrent reviews, working closely with clinical teams to coordinate care and ensure patient coverage. The role requires strong communication with Patient Financial Services and meticulous...
- ...Odyssey House is looking for a Full-Time Utilization Review Specialist. Summary: Odyssey House's Mission is "Empowering people to heal and build better lives. We are dedicated to helping individuals and families reclaim their lives through effective substance use treatment...Full timeContract workTemporary workCasual workLocal areaImmediate startFlexible hoursShift work
- Knowtion Health is seeking a Revenue Recovery Specialist focused on Workers’ Compensation to evaluate referred accounts, identify the correct payer... ...submission of bills and records. The role involves reviewing EOBs, submitting appeals for underpayments, managing multiple...Remote jobHome office
- Corewell Health is seeking an experienced RN for Utilization Management to assess clinical information, coordinate case management for complex... ...compliance. You will collaborate with physicians, social workers, and other hospital staff to optimize admission decisions and...
- ...experience to ensure our client's revenue cycle is managed in the most efficient and streamlined manner. We are seeking a ABA Utilization Review Specialist The ABA Utilization Review Specialist will utilize his or her knowledge and skills to review clinical information and...Work at officeRemote workFlexible hours
- Odyssey House is seeking a Full-Time Utilization Review Specialist to support medical necessity reviews, documentation, and coordination with billing and staff. The role emphasizes thorough UR processes, training, and timely submissions. The ideal candidate will hold a...Full timeFlexible hours
- Spectrum Billing Solutions is seeking an ABA Utilization Review Specialist to review clinical data and obtain authorized services for ABA and related treatments. This role offers either remote work or a home-office hybrid setup, with collaboration across clinical staff...Remote jobWork from homeHome office
- ...Orthopedic Spine Surgeon Reviewer (NY - Workers' Comp Certified) Dane Street is seeking experienced Orthopedic Spine Surgeons licensed in New York and certified in New York Workers' Compensation to join our growing team of independent physician reviewers. In this role...For contractorsRemote workFlexible hours
- Ethos Risk Services is hiring a full-time Bill Review Specialist (REMOTE) to review and adjudicate workers' compensation medical bills in a 100% remote U.S.-based role. The position requires strong analytical abilities, meticulous attention to detail, and experience with...Remote jobFull time
- A leading Workers' Compensation service provider is seeking a Quality Analyst to manage the medical file review process, ensuring accuracy and adherence to standards. The position requires exceptional communication skills and business experience, preferably in a healthcare...Remote job
- Case Manager - Utilization Review Specialist - Remote Full-Time Position You must reside in one of these states to be eligible for position: Arkansas... ...to established criteria and confers with medical and nursing personnel and other professional staff to determine legitimacy...Full timeRemote work
$2,959.94 per week
$2959.94/week - Job Summary: Seeking an experienced Registered Nurse specializing in utilization review to assess non-acute cases. This role involves evaluating patient records to ensure appropriate care and resource utilization while maintaining compliance with regulatory...- EnableComp is seeking a Revenue Specialist to act as a liaison between client contacts and insurance companies. This role handles patient health information with strong privacy and security. You will analyze claim payments, gather medical records, and submit claims with...
- Naukai Mitra is seeking a Remote Workers' Compensation Specialist to manage end-to-end claims from home with empathy, accuracy, and compliance. This remote role emphasizes proactive communication and data-driven decisions in a fully remote ecosystem. You will collaborate...Remote job
- ...neighbors throughout the region. Organization Utilization Management Job Summary Facilitates... ...initial admission based on utilization review medical necessity criteria. Refers cases... ...appropriate level of care setting. Our Nursing Philosophy We believe highly skilled and...Remote jobTemporary workWork experience placementLive outFlexible hours
- CVS Health is seeking a Registered Nurse (RN) for Utilization Management to ensure appropriate care delivery and coordinate patient care with clinical teams. The role emphasizes evidence-based review, care coordination, and collaboration with providers to optimize outcomes...Remote jobFull timeFlexible hoursAfternoon shift
$26.01 - $56.14 per hour
...a team that’s making a difference in the lives of 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 timely, medically necessary care through thoughtful...Hourly payFull timeTemporary workLocal areaRemote workMonday to FridayFlexible hoursShift work- Axelon Services Corporation is seeking a Nursing professional for a 6-month remote role focused on concurrent reviews and utilization management. The candidate will assess member health, determine appropriate care levels, and collaborate with Medical Affairs to support...Remote job
$45 - $51 per hour
...Laptop, keyboard, and mouse provided Pay $45.00 - $51.00 per hour Job Description Position Details Position: RN Utilization Management / Utilization Review Setting: 100% Remote Schedule: 5x8-hour days Hours: 8:00 AM 4:30 PM or 9:00 AM 5:30 PM Pacific Time Weekend: Every...Hourly payRemote workWeekend work- ...greater Phoenix area. Responsibilities: JOB SUMMARY The Utilization Review RN Specialist reviews and monitors utilization of health care services... ...Performs other duties as assigned. EDUCATION Associates in Nursing from an accredited NLN/CCNE institution Required or Bachelors...Daily paidContract workShift work
- ...underwriting professional to support Liability and Workers' Compensation operations, focusing on... ...and premium determination. You will review driver histories, handle policy quality... ...have underwriting experience in workers' comp, strong customer service, and solid computer...
- ...designed to enhance efficiency and accuracy for Workers' Compensation Adjusters. We are seeking... ..., relevance, completeness, and practical utility of the AI‑generated summaries,... ...Critical Thinking: Exceptional ability to review complex documentation (medical, legal, financial...Remote work
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