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$27.02 - $48.55 per hour
...workplace flexibility. Position Purpose Performs a clinical review and assesses care related to mental health and substance abuse... ...planning Analyzes BH member data to improve quality and appropriate utilization of services Provides education to providers, members and...SuggestedHourly payFull timeContract workPart timeWork at officeRemote workFlexible hours- ...other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services Perform other duties as assigned by the supervisor including but...SuggestedFull timeReliefWeekend work
- A large healthcare provider in Florida seeks an experienced Education Coordinator for Utilization Review and Denials Management. This full-time, hybrid position requires a Bachelor's Degree in Nursing and certifications within a year. Responsibilities include developing...SuggestedFull time
- A prominent healthcare provider in Tampa is seeking a Utilization Review RN. The position is hybrid and requires an active RN certification along with 2 years in Utilization Review and 3 years as a Registered Nurse. Ideal candidates will have experience in Critical Care...SuggestedRelief
Utilization Management (UM) Clinical Care Reviewer II - Behavioral Health - Massachusetts ONLY![...]
$62.7k - $100.4k
...quality outcomes and lower costs of care. Job Summary Clinical Care Reviewer II - Behavioral Health is responsible for processing medical... ...Work required Three (3) years clinical experience required Utilization Management/Utilization Review experience preferred Medicaid/...SuggestedHourly payWork at office- 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
- ...Coordinates with the CM RN and/or CMA to identify and complete the process for CMS required patient notices. Completes and documents utilization reviews, physician advisor referrals and other communications related to assigned cases in accordance with department policy and...SuggestedHourly payFull timeTemporary workPart timeFor contractorsFor subcontractorFlexible hoursShift work
$84.56k - $126.84k
Job Overview The Utilization Review RN participates as a member of a multidisciplinary team to support medical necessity reviews, ensure compliance, and actively participate in denial mitigation. It is a collaborative approach that uses pre-established guidelines and criteria...SuggestedFull timeImmediate startRemote workRelocationRelocation packageMonday to FridayShift workDay shift- A global consulting firm is seeking a Utilization Review Nurse in Los Angeles, CA. Responsibilities include ensuring quality care for New Century Health Plan members and conducting utilization management activities. Candidates should have a BSN or MSN, a valid California...SuggestedDay shift
$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...SuggestedFull timeWork at officeRemote workFlexible hours- 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...Suggested
- A healthcare staffing company is seeking an experienced travel nurse RN specializing in Utilization Review for a position in Fremont, California. The ideal candidate will have 2-3 years of relevant experience, an active BLS certification, and a California State License...SuggestedWeekly payContract workNight shift
$1,963 - $2,199 per month
A leading healthcare staffing company is seeking a Utilization Review Registered Nurse in Chicago, IL. This role offers competitive weekly pay ranging from $1963 to $2199. The position is for a 12-week assignment with night shifts and is ideal for nurses with over a year...SuggestedWeekly payNight shift$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...SuggestedHourly pay$45 per hour
A leading healthcare staffing company is seeking a local contract Registered Nurse for Utilization Review in Torrance, California. The position requires extensive experience in acute care and proficiency in InterQual and Epic. This fully remote role offers a stable schedule...Remote jobContract workTemporary workLocal areaFlexible hours- A healthcare management company is seeking a Utilization Review Nurse to support evaluating medical necessity requests remotely. Responsibilities include reviewing requests, ensuring compliance, and advocating for members' care needs. Candidates must be licensed nurses...Remote job
- ...healthcare management company is seeking a Nurse to conduct concurrent reviews of members' health and care setting. The role requires a Texas... .... Candidates should be able to multitask, learn quickly, and utilize technology effectively. This is a work-from-home position with...Remote jobWork from home
- 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 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...
$269.5k - $425.5k
...member of a team of medical directors, for the overall quality, effectiveness and coordination of the medical review services. Additionally, performs Utilization Management reviews and directs/coordinates aspects of the utilization review staff activities, and...Minimum wageFull timeWork experience placementLocal areaRemote workWeekend workPhoenix Staffing Services
Phoenix, AZ2 days ago- ...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
- ...organization is seeking a clinical professional to change the lives of its 28 million members. In this role, you will perform clinical reviews and assess mental health and substance abuse care, ensuring the appropriateness of services. Ideal candidates will have a nursing...Remote job
- ...requirement to come onsite as needed. You may be based outside of the greater Chicagoland area. Responsibilities Oversee daily utilization review operations across multiple hospital sites to ensure timely, compliant reviews and consistent application of UM standards....Full timeContract workWork from homeShift work
- ...retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy,... ...in acute clinical care Experience with medical record review/utilization review/utilization management Additional Information Are you...Contract workPrivate practiceMonday to Friday
- ...Assistant Nurse Manager for a hospital in the SF Bay Area. This full-time, onsite role requires a strong clinician who can lead utilization reviews and support staff. Candidates must have proven leadership experience in a union facility and an active California RN license....Full timeInterim role
- Overview Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote About Exact Billing Solutions Exact Billing Solutions is a unique team of medical billing professionals specializing in the substance use disorder, mental...Work at officeRemote workFlexible hours
$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...Hourly payFull timeWork at officeRemote work$2,494 per week
...Registered Nurse (RN) | Utilization Review Location: Camden, ME Agency: Magnet Medical Pay: $2,494 per week Shift Information: Days - 5 days x 8 hours Contract Duration: 14 Weeks Start Date: 3/16/2026 About the...Contract workFlexible hoursShift workTravelNurseSource
Camden, ME11 hours ago
