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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 $55 per hour
...Akkodis Akkodis is hiring a Concurrent Review Nurse to support our client in the Healthcare... ...: Experience in case management, utilization management, or discharge planning. Experience... ...Nurse, Out-Patient Case Manager Travel Pediatric ICU Registered Nurse - $840 per week...SuggestedFull timeContract workTemporary workLocal areaRemote work- Responsibilities Utilization Review (UR) Coordinator - Full‑Time Daytime position. Calvary Healing Center has served the Phoenix area and nationwide for over 60 years, specializing in addiction treatment for adults. The flagship Phoenix location offers detoxification...SuggestedFull timeLocal area
- ...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...SuggestedPart timeDay shift
- 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
- Currently seeking a Utilization Management RN . Please see details and qualifications below: Position is remote - candidate must reside... ...evaluate members’ clinical conditions through medical record review to determine medical necessity for services. Using advanced clinical...SuggestedImmediate startRemote workDay shift
- ...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...Suggested
$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$76k - $85k
...challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit PCG is currently seeking a Utilization Review Nurse. The Utilization nurse will also be responsible for utilizing a medical management software system on a day-to-day...SuggestedFor contractorsH1bWork at officeLocal areaRemote work- ...ensuring clients receive timely and medically necessary care. Position Overview: We are seeking a detail-oriented, proactive Utilization Review (UR) Coordinator to support insurance authorization processes across all levels of care — including Detox, Residential, PHP,...Suggested
- Summary In Utilization Management at Main Campus Lee Building Work schedule will be 7on / 7off on the Day shift, 7am- 3:30pm, Monday- Sunday every other week. Summary The UR Reviewer 1 is responsible for performing inpatient admission, concurrent, and observation reviews...SuggestedDay shift
- 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
- 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
$35 - $40 per hour
Base Pay Range $35.00/hr - $40.00/hr Location Fully Remote Position Summary The Utilization Review Nurse serves as a key liaison in coordinating resources and services to meet patients’ needs, ensuring efficient, cost-effective, and compliant delivery of home health...SuggestedContract workRemote workFlexible hoursWeekend 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- 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...
- ...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...
- Responsibilities Utilization Review Coordinator PRN/Per Diem Weekend Shifts Via Linda Behavioral Hospital is a behavioral health provider serving Scottsdale and the greater Phoenix area. We opened in February 2022 and now offer a full continuum of inpatient and outpatient...Daily paidReliefWork at officeLocal areaShift workWeekend work
- ...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
- ...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
- ...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 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
- ...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...Local areaFlexible hours
- 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...Temporary workWork at officeLocal area
$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...Work at officeRemote workFlexible hours- ...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...Hourly payFull timeWork at officeVisa sponsorshipWeekend work
- 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
- ...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
- ...appropriateness of the treatment plan in the context of insurance or managed care. Qualifications Required: RN with IL Active License, with Utilization experience; familiar with MCG and ASAM criteria. Preferred: Inpatient hospital experience or ER background. Seniority level Mid-...Contract 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
