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$27.02 - $48.55 per hour
...Utilization Review Clinician – Behavioral Health Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically...SuggestedHourly payFull timePart timeWork at officeRemote workMonday to FridayFlexible hoursCentene Corporation
United States5 days ago$27.02 - $48.55 per hour
Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine... ...Analyzes BH member data to improve quality and appropriate utilization of services Interacts with BH healthcare providers as...SuggestedHourly payFull timePart timeWork at officeRemote workMonday to FridayFlexible hours- Centene is seeking a Utilization Review Clinician to assess mental health and substance use care across the continuum. Two schedules are available, with 10-hour shifts, in Central or Eastern Time Zones. Start times: 8:00 or 9:00 AM ET. Requires RN or Master’s in Behavioral...SuggestedRemote jobShift work
- Centene Corp. seeks a healthcare professional to review ABA services for medical appropriateness and monitor clinical effectiveness... ...prior authorization reviews, data analysis to improve BH service utilization, and collaboration with BH providers. Excellent communication...SuggestedRemote job
- ...Utilization Review Specialist Senior At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of...SuggestedReliefWeekend work
$2,110 per week
...Health Advocates Network is urgently hiring Utilization Review Registered Nurses (RNs) in the Fort Myers, FL area. Must have 2 years Utilization Review experience. ~ Pay Rate: $2,110 weekly ~ Specialty: Utilization Review Registered Nurse (RN) ~ Shift: Day ~13...SuggestedWeekly payDaily paidTemporary workLocal areaImmediate startShift workHealth Advocates Network
Fort Myers, FL2 days ago- A leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services. Responsibilities include processing authorization requests, ensuring compliance with Medicare guidelines, and collaborating with...SuggestedRemote job
- Registered Nurse (RN) - Utilization Review Job Description Job Shift:Days Job Type:Full Time The individual in this position is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization...SuggestedFull timeWork at officeRemote workFlexible hoursShift work
- Kaiser Permanente is seeking a Utilization Review Nurse III to lead complex utilization management activities within our technology-driven care environment. In this role, you will review medical records for medical necessity, level of care, and appropriateness of services...Suggested
Kaiser Permanente
Renton, WA2 days ago - ...Utilization Review Specialist The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient, and compliant with regulatory standards. This position involves thorough evaluation of...Suggested
Bradford Health Services
Lucedale, MS1 day ago $20 - $36 per hour
...Utilization Review Lvn Nurse Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a...SuggestedHourly payMinimum wageFull timeWork experience placementWork at officeLocal area- ...week. At Bradford Health Services, we don't just invest in our patients-we invest in our people. About the Role: The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient...SuggestedPart timeRemote work
ADDICTION AND MENTAL
United States2 days ago - A healthcare solutions company is seeking a Utilization Management Nurse Reviewer to assess the appropriateness of medical services and collaborate with healthcare professionals. This role requires a Licensed Practical/Vocational Nurse with clinical experience and skills...Suggested
- 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...Suggested
- ...healthcare patients receive. We are looking for motivated individuals who want to be part of our mission and join our team! As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise and judgement along with established medical...SuggestedRemote jobLocal area
- 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...
- Kelsey-Seybold Clinic, part of the Optum family, seeks a Utilization Review LVN to review medical necessity and benefit correlations for UR requests. The role facilitates communication with clinics, payors, and customers, ensuring timely pre-certifications and accurate...
- Kelsey-Seybold Clinic, part of the Optum family, is hiring a Utilization Review LVN nurse in Houston area. The role involves data entry, eligibility verification, and coordinating with insurers for pre-certification. Requirements include TX LVN license and UR experience...Remote jobHourly pay
- Optum is seeking a Utilization Review Nurse, RN to perform inpatient utilization management, applying evidence-based guidelines and medical necessity criteria. The role involves day-to-day clinical reviews, documentation, and collaboration with Medical Leadership across...Remote job
- HonorHealth in Arizona seeks an Utilization Review RN Specialist to review and monitor utilization for cost-effective, high-quality care. This role ensures medical necessity across Medicare, AHCCCS, and other payers, both on admission and concurrently. The position requires...Remote job
- A healthcare management organization is seeking experienced Physician Reviewers to join their Medicare Utilization Management team in a remote position. Responsibilities include reviewing clinical service requests, applying evidence-based guidelines, and collaborating...Remote job
$68.28k - $110.27k
...admitting teams concerning patient status determinations and utilization of hospital resources facilitating quality, cost-effective patient... ...appropriate status determinations through the utilization review process supporting quality, cost-effective patient outcomes. Responsible...Full timeLocal area- Integra Partners, a national DMEPOS network administrator, seeks a remote Utilization Review Medical Director. You will conduct clinical reviews of DMEPOS requests, ensure determinations meet Medicare/Medicaid guidelines, and maintain high-quality documentation in a fast...Remote jobFull time
- ...seeking a Pharmacy Coordinator – Fraud, Waste, and Abuse (FWA) to support the Medical Management/Health Services team remotely. You will review FWA referrals, assist with regulatory requests, and help analyze and document investigations. The role requires 3+ years of...Remote work
Centene Corporation
Florida, NY2 days ago $40.12 - $62.19 per hour
Utilization Review Nurse RN - Grace Medical Center Baltimore, MD GRACE MEDICAL CENTER Part-time - Weekends - Day shift - 8:00am-4:30pm RN OTHER 96385 $40.12-$62.19 Experience based Posted:April 28, 2026 Apply Now Save Job Saved Summary JOB...Part timeShift workWeekend workDay shift$20 - $30 per hour
...the behavioral health industry by delivering exceptional care, utilizing state-of-the-art facilities, and prioritizing the well-being of... ...: Exempt Travel Requirement: None Responsibilities Utilization Review on Behalf of the Clinics: Prescreen referrals to project/anticipate...Remote workGuidelight Health
New York, NY5 days ago- ...Utilization Review Specialist The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient, and compliant with regulatory standards. This position involves thorough evaluation of...
Bradford at Warrior
Jacksonville, FL5 days ago - Join Optum/UnitedHealth Group to support behavioral health and substance abuse case management through utilization reviews and care coordination. While not a member facing role, you'll help ensure they receive the right level of care at the right time. This is a fully remote...Remote workMonday to Friday
Optum
Tucson, AZ1 day ago - ...Behavioral Health Utilization Management Coordinator This position is responsible for coordinating, integrating, and monitoring the... ...entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case Management to address member...Contract workWork at office
- Centene Corporation in Florida is seeking a qualified professional to review ABA services and member health status to ensure medical appropriateness and regulatory compliance. You will monitor outcomes and coordinate care with BH teams. The ideal candidate holds BCBA certification...Remote job
