Get new jobs by email
$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- ...We are home to Nevada’s ONLY Level I Trauma Center, Designated Pediatric Trauma Center, Burn Care Center, and Transplant Center. We are... ...facility by ANCC, and we are on our journey to Magnet status. Review patient admissions for appropriateness, efficiency of resource...SuggestedWork at officeShift workWeekend work
- Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical... .... Every day, you will meticulously review medical records, authorize services, and... ...emergency centers offering adult and pediatric care for the Greater Houston area. #J-1...Suggested
$52.26 - $81.13 per hour
...Description The Utilization Review (UR) Nurse has a strong clinical background blended with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing...SuggestedMinimum wageFull timeLocal areaShift work- ...and healing environment that improves patient outcomes and empowers patients toward long-term recovery. Position Summary The Utilization Review Specialist is responsible for managing all aspects of insurance authorization and concurrent review for assigned patients....Suggested
$18 - $20 per hour
Utilization Review Coordinator Primary Purpose To assign utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment. Are you an ideal candidate? We are looking for enthusiastic...SuggestedWork at officeLocal areaFlexible hours- ...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...Suggested
$73k - $75k
...Place to Work® Fortune Best Workplaces in Financial Services & Insurance PRIMARY PURPOSE To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates...SuggestedWork at officeFlexible 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...SuggestedHourly payRemote 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...Suggested
- ...admission through discharge. Serves as liaison to on-site external reviewers. Uses Midas for recording reviews and tracking denials. Adds... ...in applicable field of study required Six months psychiatric utilization review either for hospital or external review organization...SuggestedLocal areaFlexible hours
- ...PA, NJ, or DE Employment type: Contract to full-time hire Position Overview: We are seeking a skilled and detail-oriented Utilization Review RN with a valid PA license (or Compact)to join our team. This position is ideal for an RN with prior work in insurance utilization...SuggestedFull timeContract workRemote work
- A leading healthcare provider is seeking a Full-time Utilization Review Coordinator in Columbia, South Carolina. This role involves precertifying and verifying benefits, coordinating caseload management, and collaborating with treatment teams. Candidates should have a...SuggestedFull time
- ...employment)* Employer-paid Accident & Life Insurance (eligible after 60 days of employment)**Job Description:** The role of the Utilization Review Coordinator is to implement the organization’s Utilization Review (UR) process to ensure appropriate usage of available...SuggestedFull timeRemote work
$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- 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...Work at officeLocal area
$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...Hourly payFull timePart timeWork at officeFlexible hoursWeekend work- ...Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week. About the Role The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient...Full timePart time
- ...range of behavioral health problems. As a part of our continued success and growth, we are seeking qualified applicants for a Utilization Review Manager. Position Description: The Utilization Manager is responsible for directing and overseeing the Utilization Program...Local area
- Position Overview This Utilization Review role is primarily responsible for accurate data entry and administrative support, including patient scheduling and registration via phone and computer systems. The position also plays an important front‑line role in client engagement...
- ...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,...Private 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...Part timeWork at officeFlexible hours
- 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
- Job Title: Utilization Review Specialist Job Type: Full Time (FT) Your Experience Matters At Cottonwood Springs, we are committed to empowering and supporting a diverse and determined workforce that can drive quality, scalability, and significant impact across our hospitals...Full timeTemporary workFlexible hours
- ...plan of care for members based on authorization and concurrent review. Provides monthly telephonic outreach to ensure members needs are... ...network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards,...Contract workRemote workMonday to FridayFlexible hours
- ...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
- ...Summary Performs admission and concurrent stay medical record review to determine appropriateness of admission, continued stay, and... ...discussing patient, work, or LMC‑related information with others. Utilizes the service recovery process to resolve complaints (GIFT)....Full timeTemporary workWork at officeFlexible hours
- Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring treatment aligns with clinical guidelines, regulatory requirements, and patient needs. This role requires reviewing provider requests, gathering necessary medical...Remote workMonday to FridayFlexible hoursWeekend work
- ...supervision of the HIM manager, the UR specialist monitors the utilization of resources, risk management and quality of care for patients... ...guidelines. Excellence in Practice: Performs preadmission review on admissions when required by insurance companies/agencies to...
- ...success. Job Description • Responsible for conducting timely reviews of all requests for services required to meet medical necessity... ...providers against plan review criteria and benefit guidelines • Utilizes clinical information to determine if criteria for medical necessity...