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- ..., level of care, and duration of treatment required for basic reviews, and collaborating with the health care team, members, and caregivers... ...the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and...SuggestedTemporary workLocal area
Kaiser Permanente
Wailuku, HI23 hours ago $71.61k - $111k
Utilization Review Nurse page is loaded## Utilization Review Nurselocations: 43 New Scotland Avenue Albany, NY 12208time type: Full timeposted... ...to the region’s largest hospital, only Level 1 adult and pediatric trauma centers, and only children’s hospital. The downtown campus...SuggestedShift work- The Inpatient Behavioral Health Social Worker in Utilization Review is responsible for evaluating the medical necessity, appropriateness, and efficiency of behavioural health services provided to patients in an inpatient setting. This role ensures compliance with regulatory...Suggested
$65 per hour
...coordinate patient care, manage resources, and ensure appropriate utilization of healthcare services while maintaining high-quality patient... ...care planning and discharge planning. Conduct utilization review to ensure appropriate level of care and services. Collaborate...SuggestedHourly payWeekly payLocal areaShift work$17.44 per hour
Agency 452 MENTAL HEALTH AND SUBSTANCE ABUSE SERV. Job Posting Title Utilization Review Specialist I Supervisory Organization Tulsa Center Behavioral Health Job Posting End Date Refer to the date listed at the top of this posting, if available. Continuous if date is...SuggestedHourly payFull timePart timeWork at officeFlexible hoursWeekend work- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving...SuggestedWork at officeLocal area
- ...care services in alignment with the physician’s treatment plan. Utilizes strong clinical skills to assess, plan, implement, coordinate,... .... Ensures case management program objectives are met by reviewing the effectiveness of alternative care services while maintaining...SuggestedContract workImmediate startRemote work
- ...network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately... ...retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy,...SuggestedPrivate practiceImmediate start
- ...faxing discharge clinical information Accurately enter information into the UR spreadsheet Schedule and follow up on peer-to-peer reviews Assist the UR Manager with data reporting as directed Ensure all Medicare certification letters are signed by the appropriate provider...SuggestedPart timeWork at officeFlexible hours
- Responsibilities Three Rivers Midlands is seeking a dynamic & talented Full‑time Utilization Review Coordinator. Three Rivers Midlands is a comprehensive behavioral health facility treating children and adolescents through residential and Rehabilitative Behavioral Health...SuggestedFull timeLocal area
- Description Job Summary The UR Coordinator’s primary responsibility is managing, reviewing, and monitoring utilization of patient resources and obtaining payor authorization as required for all provided services. The UR Coordinator will function as liaison between payor...SuggestedTemporary workWork at officeLocal area
- ...want to impact others in a meaningful way - we warmly invite you to join our growing family! We are currently seeking to hire Utilization Review Specialists to join our corporate NJ Team! The Utilization Review Specialist collaborates with Avenues Recovery facilities...SuggestedTemporary workCurrently hiringFlexible hours
- ...contribute meaningfully. Note: New Jersey RN Active License is required. Role Description This is a Field work contract role for a Utilization Review Nurse. The Utilization Review Nurse will be responsible for performing utilization management, reviewing medical records,...SuggestedContract workRemote work
$54 - $66 per hour
We are recruiting for a Utilization Review Nurse to join a large healthcare organization within the Sacramento region. The Utilization Review Nurse is responsible for overseeing the daily operations of the UM Pre-Authorization team, ensuring referral requests are processed...SuggestedContract workWork at office$24 - $56.17 per hour
A prominent healthcare provider based in New York is seeking a professional to provide support for clinical member services review processes. The role involves ensuring services are medically necessary and compliant with established guidelines. Candidates should possess...SuggestedHourly payWork at office- Copper Springs East Job Title: Utilization Review Specialist Job Type: Full‑time Your experience matters At Copper Springs East, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact...Full timeTemporary workFlexible hoursShift work
- Utilization Review Pharmacist Shape the drug benefit landscape—analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective...
- ...through all levels of care in the substance abuse and mental health setting. Works with the UR Director and facility contacts on case reviews for pre-service, concurrent, and retrospective authorizations and appeals, looking for medical necessity and appropriateness of...Full timePart timeRemote work
- ...conversation can turn into a long-lasting and rewarding career! Job Description Are you an experienced Registered Nurse with Utilization Review experience professional looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance...Private practiceMonday to Friday
- ...coast. We are driven by a profound commitment to prioritize your well‑being so you can provide exceptional care to others. As a Utilization Review Specialist joining our team, you're embracing a vital mission dedicated to making communities healthier®. Join us on this...Full timeTemporary workPart timeMonday to FridayFlexible hours
- Insight Global is looking for a Utilization Review Registered Nurse to sit remotely with one of their large health insurance clients. This person will be responsible for evaluating 3.5 patient care cases per hour (both inpatient and outpatient) and collaborating with doctors...Hourly payRemote work
- ...that sets us apart from many other treatment facilities, and our tenured team includes seasoned medical staff. Website: The Utilization Review Coordinator opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical...
- RN- Utilization Review Nurse Inpatient (*Hybrid*) Must reside within the New York Tri-State Area - NY, NJ, or CT. COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE! Responsibilities Reviews planned, in process, or completed health care services to...Local areaWork from home
$4,801.16 - $7,761.5 per month
...advancement, and more. Benefits of Working at HHS webpage contains additional details. Position Details Functional Title: Utilization Review Nurse Job Title: Nurse II Agency: Health & Human Services Comm Department: UR Wav & Comm Srvs Ran Mmt St Posting Number:...Full timeTemporary workPart timeWork at officeRemote workShift work- ...direct clinical experience in a psychiatric or mental health setting Experience in treatment planning and communication with external review organizations or comparable entities Valid fingerprint clearance card Completion of BLS & First Aid certification within 30 days...Full timeLocal areaShift work
- ...knowledge of local and national coverage determinations Recent work experience in a hospital or insurance company providing utilization review services Knowledge of Medicare, Medicaid, and Managed Care requirements Progressive knowledge of community resources, health...Permanent employmentWork experience placementLocal area
- ...coast. We are driven by a profound commitment to prioritize your well‑being so you can provide exceptional care to others. As a Utilization Review Clerk joining our team, you’re embracing a vital mission dedicated to making communities healthier. Join us on this...Full timeTemporary workPart timeWork at officeMonday to Friday
- ...psychiatric care and passionate about ensuring patients receive the right level of care at the right time? We are seeking a dedicated Utilization Review (UR) Specialist to join our team and support our mission of delivering quality behavioral health services. What You’ll Do...
- A healthcare facility in Augusta, Georgia, is seeking a Utilization Review Coordinator to join their Case Management team. The role involves reviewing clinical data, collaborating with medical staff, and ensuring compliance with insurance authorization processes. Ideal...
$42.18 - $51.56 per hour
The Role Ready to help us transform healthcare? Bring your true colors to blue. The Physical Therapy Utilization Management Reviewer is responsible for evaluating the appropriateness and medical necessity of outpatient rehabilitation and other services within scope of practice...Hourly payFull timeWork at officeFlexible hoursShift work
