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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... 
    Suggested
    Temporary work
    Local area

    Kaiser Permanente

    Wailuku, HI
    23 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... 
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    Shift work

    Albany Medical College

    Albany, NY
    2 days ago
  • 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... 
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    Waterbury Hospital

    Waterbury, CT
    2 days ago
  • $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... 
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    Hourly pay
    Weekly pay
    Local area
    Shift work

    Pride Health

    New York, NY
    2 days ago
  • $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... 
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    Hourly pay
    Full time
    Part time
    Work at office
    Flexible hours
    Weekend work

    State of Oklahoma

    Tulsa, OK
    2 days ago
  • 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... 
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    Work at office
    Local area

    Briteliferecovery

    Englewood Cliffs, NJ
    2 days ago
  •  ...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... 
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    Contract work
    Immediate start
    Remote work

    w3r Consulting

    Nashville, TN
    1 day ago
  •  ...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,... 
    Suggested
    Private practice
    Immediate start

    Healthcare Support Staffing

    Indianapolis, IN
    3 days ago
  •  ...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... 
    Suggested
    Part time
    Work at office
    Flexible hours

    Triangle Springs

    Raleigh, NC
    3 days ago
  • 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... 
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    Full time
    Local area

    SupportFinity™

    West Columbia, TX
    2 days ago
  • 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... 
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    Temporary work
    Work at office
    Local area

    Axiomcareofaz

    Phoenix, AZ
    4 days ago
  •  ...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... 
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    Temporary work
    Currently hiring
    Flexible hours

    AVENUES RECOVERY CENTER

    Toms River, NJ
    4 days ago
  •  ...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,... 
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    Contract work
    Remote work

    Rangam

    Pennington, NJ
    4 days ago
  • $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... 
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    Contract work
    Work at office

    Pacific Staffing

    Sacramento, CA
    1 day ago
  • $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... 
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    Hourly pay
    Work at office

    Molina Healthcare

    New York, NY
    1 day ago
  • 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 time
    Temporary work
    Flexible hours
    Shift work

    Lifepoint Health

    Gilbert, AZ
    2 days ago
  • 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... 

    Pharmacy Careers

    Fremont, CA
    2 days ago
  •  ...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 time
    Part time
    Remote work

    MALIBU GROUP LLC

    Malibu, CA
    2 days ago
  •  ...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 practice
    Monday to Friday

    Healthcare Support Staffing

    Brentwood, TN
    12 hours ago
  •  ...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 time
    Temporary work
    Part time
    Monday to Friday
    Flexible hours

    Lifepoint Health®

    Avondale, AZ
    3 days ago
  • 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 pay
    Remote work

    Insight Global

    Raleigh, NC
    2 days ago
  •  ...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... 

    Universal Hospital Services Inc.

    New York, NY
    2 days ago
  • 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 area
    Work from home

    VillageCare

    New York, NY
    4 days ago
  • $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 time
    Temporary work
    Part time
    Work at office
    Remote work
    Shift work

    Texas Health and Human Services

    San Antonio, TX
    4 days ago
  •  ...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 time
    Local area
    Shift work

    Calvary Healing Center

    Phoenix, AZ
    4 days ago
  •  ...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 employment
    Work experience placement
    Local area

    Houston Methodist

    Houston, TX
    4 days ago
  •  ...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 time
    Temporary work
    Part time
    Work at office
    Monday to Friday

    Memorial Physician Practices

    Avondale, AZ
    3 days ago
  •  ...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... 

    Thrive Behavioral Hospital

    Las Vegas, NV
    2 days ago
  • 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... 

    Universal Hospital Services Inc.

    New York, NY
    2 days ago
  • $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 pay
    Full time
    Work at office
    Flexible hours
    Shift work

    Blue Cross Blue Shield of Massachusetts

    Hingham, MA
    1 day ago