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$27.02 - $48.55 per hour
...AM to 5PM AZ Time. Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse... ...Analyzes BH member data to improve quality and appropriate utilization of services Provides education to providers members and...SuggestedHourly payFull timePart timeWork at officeRemote workMonday to FridayFlexible hoursCentene Corporation
Phoenix, AZ1 day ago$2,273.12 per month
...Georgia Regional Offices Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 36177996 Job Title RN - Utilization Review Weekly Pay $2273.12 Shift Details...SuggestedWeekly payShift workDay shiftKaiser Permanente
Atlanta, GA4 days ago$97.59 - $112.64 per hour
...care, and duration of treatment required for moderately complex reviews, and collaborating with the health care team, members, and... ...ensure the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and...SuggestedFull timeTemporary workWork experience placementLocal areaWork from homeFlexible hoursShift workKaiser Permanente
Pleasanton, CA4 days ago- ...The County of Riverside's - RUHS-Medical Center Department is seeking a Utilization Review Technician to support the UR Case Management Division in Moreno Valley. Under general supervision, performs a variety of clerical and data collection tasks and acts as a liaison...SuggestedWork at officeImmediate start
County of Riverside
Moreno Valley, CA3 days ago $62.7k - $100.4k
...outcomes and lower costs of care. Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for... ...acute clinical care or home health experience preferred Utilization Management/Utilization Review experience preferred Medicaid...SuggestedHourly payWork at officeRemote workCareSource
Boston, MA3 days ago- ...experienced individual for a position involving advanced clinical and regulatory consultation. Responsibilities include conducting utilization reviews, collaborating with the healthcare team, and advising on treatment plans. Candidates must have a Bachelor's degree in Nursing...Suggested
- ...Atlanta location to perform precertification and medical necessity reviews on referrals, targeted outpatient procedures, and inpatient... ...state regulations. Ideal candidates will have experience in utilization management. The position supports a collaborative healthcare environment...Suggested
- ...Job Title Primary Responsibilities Perform prospective, concurrent, and retrospective utilization reviews and first level determination approvals for members using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies...SuggestedContract workWork at officeFlexible hours
Brighton Health Plan Solutions
Chapel Hill, NC1 day ago $1,630 per week
...Skyline Med Staff Nursing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Torrance, California. Job Description & Requirements ~ Specialty: Utilization Review ~ Discipline: RN ~ Start Date: 03/16/2026 ~ Duration...SuggestedHourly payZero hours contractRemote workShift workSkyline Med Staff Nursing
Torrance, CA3 days ago- Description Job Title RN - Utilization Review Nurse; Senior Care Supervised by RN Nurse Director, Case Management Job Summary The Behavioral Health Utilization Review (UR) Nurse ensures appropriate utilization of inpatient psychiatric services for geriatric patients...SuggestedWork at office
$248.5k - $373k
...expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools... ...primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and...SuggestedMinimum wageWork experience placementLocal areaRemote workUnitedHealth Group
United States3 hours agonew- A leading health care organization is seeking a Remote RN with experience in Utilization Review and patient care. The role involves working Monday to Friday, supporting the Medicare team without direct patient communication. Candidates must have at least 2 years of RN...SuggestedRemote jobMonday to Friday
- A leading healthcare provider in Los Angeles seeks a Registered Nurse for the Utilization Review Case Manager role. The position requires strong clinical judgment and regulatory knowledge to manage post-discharge clinical reviews and payer denials effectively. Candidates...Suggested
- Description Under the direction of the Assistant Director, the ICM Medicare Advantage Utilization Review Nurse performs utilization review of medical necessity and appropriateness, cost containment and efficiency, compliance with regulations and contracts, care coordination...SuggestedWork at officeFlexible hours
- ...RN Case Manager - Utilization Review At The CORE Institute, we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following: ~ Competitive Health & Welfare Benefits ~ Monthly $43 stipend to use toward...SuggestedPart time
HOPCo | Healthcare Outcomes Performance Company
Phoenix, AZ1 day ago - A healthcare management company is seeking a full-time Utilization Review Specialist for a remote position. The role focuses on efficiently processing Utilization Management and Independent Review requests, reviewing case requests, maintaining compliance, and delivering...Remote jobFull timeWork at office
- A healthcare billing company is seeking a Vice President of Utilization Review to oversee revenue cycle management operations in Lauderdale Lakes, FL. This senior leadership role focuses on strategic direction, operational efficiency, and driving transformation in out-...
- A healthcare administration company seeks a Utilization Management Nurse to perform medical necessity reviews while working remotely. The ideal candidate will be an active Licensed Practical Nurse (LPN) with strong proficiency in the Utilization Review process. Responsibilities...Remote job
- A healthcare performance company is seeking a Clinical Care Manager to advance patient-centered care through precise Utilization Review. The role involves evaluating healthcare services, ensuring medically necessary care, and collaborating with providers. Candidates should...Remote job
- A prestigious healthcare company in Brentwood, TN is seeking an experienced Registered Nurse for the Utilization Review position. You will telephonically review medical information to determine the necessity of continued stay while ensuring compliance with CMS criteria...
$33 - $41 per hour
A healthcare company in Haverhill, MA, is seeking a Utilization Review Specialist to manage patient care evaluations. This full-time position involves reviewing medical records, collaborating with clinical teams, and ensuring compliance with insurance requirements. The...Hourly payFull timeMonday to Friday- A healthcare company is seeking a Registered Nurse for Utilization Management in Michigan. This role involves reviewing services and patient care quality, conducting stay reviews, and preparing appeals to payors. Candidates must be licensed in Michigan with three years...Work at office
$28 - $32 per hour
A healthcare solutions company in Chicago is seeking a Utilization Review Specialist. This role involves initiating communications with various stakeholders, conducting reviews, and managing medical documentation efficiently. Ideal candidates will have a current LPN/LVN...Hourly pay- A healthcare management company is seeking an experienced Utilization Review Nurse to support inpatient and outpatient medical necessity reviews. This hybrid role involves reviewing admissions, continued stays, and discharge planning while ensuring appropriate care levels...Monday to Friday
- A national healthcare staffing firm is seeking an experienced Registered Nurse for a position focused on Utilization Review. This role involves collaborating to enhance care continuity and conducting reviews for Medicaid and Medicare patients. The ideal candidate will...
- A healthcare company is seeking an experienced Utilization Review Nurse for a remote position to join its Utilization Management team. The ideal candidate will have an active RN license in PA or a Compact license and a minimum of 3 years of acute care experience. Responsibilities...Remote jobWork at office
- A growing healthcare company in New York seeks a Utilization Review Nurse to conduct clinical reviews and ensure medical necessity authorizations are met. The ideal candidate will be an LPN or RN with critical thinking skills and attention to detail, able to manage tasks...
- A leading healthcare company based in Florida is seeking a Vice President of Utilization Review to lead strategic operational functions in revenue cycle management. The role emphasizes improving operational practices and driving business transformation while ensuring service...
$200k - $230k
Vice President of Utilization Review - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - In Office - No Remote Salary Range: $200K - $230K This is a full-time, on-site role requiring daily presence at our Lauderdale Lakes, FL location. About Exact Billing Solutions...Full timeWork at officeRemote workFlexible hours- ...assess care related to mental health and substance abuse. This role involves evaluating treatment needs, performing authorization reviews, and improving service quality. Ideal candidates should have strong behavior health experience and a relevant license. This position...Remote jobFlexible hours
