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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, HI1 day ago - ...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
$51.43 - $79.84 per hour
...remote role. You MUST live in the state of Washington (WA) to be considered. Care Manager RN, Per diem / On call, Day shift. The Utilization Review (UR) Nurse has a strong clinical background blended with knowledge and skills in Utilization Management (UM), medical...SuggestedDaily paidLive inRemote workShift workDay shift- 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...SuggestedFull timeTemporary workFlexible hoursShift work
- ...growth‑focused business model, strong finances, and expert management team, Praesum will continue to grow in the years to come. Utilization Review Specialist Job Description Perform duties to authorize and review utilization of mental health and substance abuse services...SuggestedHourly payFull timeWork at officeVisa sponsorshipWeekend work
$55k - $70k
Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary $55K - $70K Who We Are Exact Billing Solutions is a unique team of revenue‑cycle management professionals specializing in the substance use disorder, mental...SuggestedWork at officeRemote workFlexible hours- 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
$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- ...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
- Overview 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 Services...SuggestedFull timeLocal area
- ...medical necessity and appropriateness of the treatment plan . This position is responsible for performing accurate and timely medical review of claims suspended for medical necessity, contract interpretation, pricing; and to initiate and/or respond to correspondence from...SuggestedFull timeContract workRemote work
- ...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,...SuggestedContract workRemote workMonday to FridayFlexible hours
- Job No: 497118 Department: Medical Care Review Local Title: Utilization Review Nurse Budget Title: Teaching Hospital Quality Assurance Senior Coordinator Work Type: Full Time Location: Brooklyn, NY Categories: Administrative, Nursing, Patient Care Job Summary The...SuggestedFull timeReliefLocal areaMonday to Friday
- ...online at: Via Linda Behavioral Health. Position Description The Utilization Management Coordinator reports to the Utilization Management... ...services. Interface with managed care organizations, external reviewers, and other payors for initial reviews, continued stay reviews...SuggestedDaily paidReliefWork at officeLocal areaShift workWeekend work
- ...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...SuggestedFull timeTemporary workPart timeMonday to FridayFlexible hours
- ...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...
$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- ...with behavioral health providers to offer a full suite of administrative solutions, including comprehensive medical billing, utilization review services, and credentialing support. Our mission is to simplify the complexities of revenue cycle management, helping providers...
- ...Job Description Job Description POSITION POSTING: Utilization Review DEPARTMENTS: Nursing STATUS Part-Time: 24 hours per week HOURS : Day shift. Hours may be adjusted in response to workload demands; Low census may be utilized in accordance with hospital...Part timeDay shift
- This position requires prior UM experience. Major Responsibilities Documents utilization review activity per department and medical center standards in a timely manner. Performs and documents accurate and timely concurrent and retrospective reviews based on approved...Work at office
$45.9 - $71.4 per hour
Utilization Review RN - Remote Providence Health Plan caregivers are not simply valued - they’re invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual...Remote jobLocal area- Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for...Remote work
- ...forward‑thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence. The Utilization Review Specialist Senior responsibilities include: Functions as the primary liaison between the funding agents and all other...ReliefWeekend work
- Utilization Review Nurse for Workers' Comp Office Location - Montgomery County Area Job Purpose: Review Workers Compensation requests submitted by the provider, requestor, claimant or carrier to determine the medical necessity of the treatment utilizing clinical expertise...Work at office
$23.08 - $37.02 per hour
A leading pharmacy benefits manager is seeking an Initial Review Pharmacy Technician in Lansing, Michigan. In this role, you will manage medication requests and ensure adherence to clinical guidelines. Responsibilities include reviewing patient information, conducting...- A health care management company is seeking an Initial Review Pharmacy Technician to support medication reimbursement processes. You'll review patient clinical information, recommend approvals, and ensure compliance with clinical criteria. Ideal candidates possess strong...Full time
- ...interdisciplinary team in the provision of patient care by ensuring the appropriate level of care at the point of entry. The utilization review nurse will work on defined patient populations and is responsible for an initial clinical review at the point of patient entry...Rotating shift
- ...culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary The Social Worker-Utilization Review monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, admissions, and...
$23.08 - $37.02 per hour
A leading pharmacy benefits manager in Tallahassee is seeking an Initial Review Pharmacy Technician. This role involves reviewing medication requests and making recommendations based on clinical criteria. The ideal candidate will have at least 4 years of pharmacy experience...$17.44 per hour
A state agency in Tulsa is seeking a Utilization Review Specialist I responsible for reviewing clinical documentation to ensure the appropriateness of admissions and ongoing care. The position requires a bachelor's degree or equivalent experience in social work or psychology...Hourly payFull time
