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  • $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... 
    Suggested
    Minimum wage
    Full time
    Local area
    Shift work

    Providence Health and Services

    Renton, WA
    2 days ago
  • Overview 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. Responsibilities Accesses, triages and assigns cases for utilization review (UR).... 
    Suggested
    Work at office
    Local area

    Sedgwick

    Florida, NY
    1 day ago
  •  ...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,... 
    Suggested
    Contract work
    Remote work
    Monday to Friday
    Flexible hours

    Healthcare Support Staffing

    New York, NY
    1 day ago
  •  ...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-... 
    Suggested
    Contract work

    w3r Consulting

    Chicago, IL
    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... 
    Suggested
    Temporary work
    Work at office
    Local area

    Axiomcareofaz

    Phoenix, AZ
    2 days ago
  •  ...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... 
    Suggested
    Full time
    Contract work
    Remote work

    Innovative Systems Group

    Richardson, TX
    1 day 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:... 
    Suggested
    Full time
    Temporary work
    Part time
    Work at office
    Remote work
    Shift work

    Texas Health and Human Services

    San Antonio, TX
    2 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... 
    Suggested
    Permanent employment
    Work experience placement
    Local area

    Houston Methodist

    Houston, TX
    2 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... 
    Suggested
    Temporary work
    Currently hiring
    Flexible hours

    Avenues Recovery

    Jackson, NJ
    4 days ago
  • $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... 
    Suggested
    Contract work
    Remote work
    Flexible hours
    Weekend work

    IntePros

    Phoenix, AZ
    5 days ago
  •  ...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

    Ambrosia Treatment Center

    West Palm Beach, FL
    5 days ago
  •  ...Utilization Review Manager We are currently seeking a Utilization Review Manager to join our Transitional Care Team. This is a full-time management role and will be required to work onsite. The purpose of this position is to manage the design, development, implementation... 
    Suggested
    Full time
    Work at office

    Minnesota Jobs

    Minneapolis, MN
    2 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 Director joining our team, you're embracing a vital mission dedicated to making communities healthier. Join us on this... 
    Suggested
    Full time
    Temporary work
    Part time
    Work at office

    Lifepoint Health

    Georgetown, TX
    4 days ago
  • $45.9 - $71.4 per hour

    Utilization Review RN - Remote The RN Care Coord-Qual Med Mgmt will provide administration of medical management programs for prior authorization. These programs are developed to manage medical expense, determine medically appropriate services and define clinical criteria... 
    Suggested
    Remote job
    Local area

    Providence Health Plan Group

    Portland, OR
    2 days ago
  • Via Linda Behavioral Hospital in Scottsdale is seeking a Utilization Review Coordinator to manage the assessment and efficiency of services. This role involves interfacing with external payors and promoting high-quality patient care through clinical evaluations. Candidates... 
    Suggested
    Work at office
    Weekend work

    Via Linda Behavioral Hospital

    Scottsdale, AZ
    2 days ago
  • A leading pharmacy benefit manager is seeking an Initial Review Pharmacy Technician in Des Moines, Iowa. The role involves critical tasks in medical and pharmacy management, such as reviewing requests for medication appropriateness and providing clinical consultation to... 

    Prime Therapeutics

    Des Moines, IA
    3 days ago
  •  ...Monday - Friday from 8am-4:30pm. Requirements 2 years of RN experience performing care for hospitalized patients 2 years of Utilization Review (UR) experience reviewing hospital admissions for medical necessity Must live within one hour of the BJC Commons (4249 Clayton... 
    Full time
    Relief
    Local area
    Remote work
    Work from home
    Monday to Friday
    Flexible hours
    Shift work

    BJC HealthCare (New)

    Des Moines, IA
    1 day ago
  •  ...organization in New York, NY is seeking a Durable Medical Equipment Review Coordinator to ensure high quality, cost-effective services...  ...least two years of managed care experience. Familiarity with utilization management and case management is strongly preferred. This... 

    MJHS

    New York, NY
    3 days ago
  • Responsibilities We are pleased to announce the following available position: FT Utilization Review Coordinator, including weekends. This position is responsible for monitoring the treatment activities offered to the patient, interfacing with the treatment team/managed... 
    Local area

    Universal Health Services

    Jacksonville, FL
    3 days ago
  • A leading behavioral health facility in Georgia is seeking a Utilization Review Coordinator to join their Case Management team. This role requires a Master's level education in social science and must also be licensed or license-eligible in Georgia. The ideal candidate... 

    Lighthouse Care Center of Georgia, LLC

    New York, NY
    4 days ago
  • $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 pay
    Full time

    State of Oklahoma

    Tulsa, OK
    5 days ago
  • A leading healthcare provider in Jacksonville is seeking a TEMP FT Utilization Review Coordinator to monitor treatment activities and ensure quality patient care. The ideal candidate will have a nursing or social work background with experience in Utilization Management... 
    Temporary work
    Weekend work

    Universal Health Services

    Jacksonville, FL
    5 days ago
  • $72.23 - $99.98 per hour

     ...RN Case Manager assists patients in the utilization of appropriate health care services....  ...required to know and understand will be reviewed and evaluated during job specific/department...  ...s services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-... 
    Daily paid
    Minimum wage
    Local area
    Shift work

    Providence

    Napa, CA
    4 days ago
  •  ...Director Of Utilization Management $10,000 Sign On Bonus Riveredge Hospital is seeking a talented and dynamic Director of Utilization...  ...services and interfaces with managed care organizations, external reviewers and other payers. Duties include, but are not limited to:... 
    Work at office
    Local area
    Relocation package

    Universal Health Services

    River Edge, NJ
    5 days ago
  •  ...Manager Centralized Utilization Review At Houston Methodist, the Manager Centralized Utilization Review (UR) position is responsible for leading the daily operations of the Utilization Review department to ensure efficient, high-quality, and compliant utilization management... 
    Permanent employment

    Houston Methodist

    Houston, TX
    1 day ago
  • $27.02 - $48.55 per hour

     ...psychiatric experience. Position Purpose Performs a clinical review and assesses care related to mental health and substance abuse...  .... Analyzes BH member data to improve quality and appropriate utilization of services. Provides education to providers, members and their... 
    Hourly pay
    Full time
    Part time
    Work at office
    Remote work
    Monday to Friday
    Flexible hours
    Weekend work

    Centene Corporation

    Florida, NY
    2 days ago
  • Sedgwick is seeking an Administrative Support Specialist in Town of Florida, New York. The role involves managing utilization review requests, verifying data, and providing general support to clinical staff. Candidates should have a High School diploma or GED and two years... 
    Work at office

    Sedgwick

    Florida, NY
    1 day ago
  • A leading healthcare staffing firm is seeking a Registered Nurse for Concurrent Review in Florida. The role involves telephonic review of inpatient admissions to ensure appropriate medical necessity and care levels. Candidates must have an active RN license in Florida... 
    Full time
    Work at office
    Monday to Friday

    Healthcare Support Staffing

    Florida, NY
    2 days ago
  • $30.37 - $59.21 per hour

     ...DESCRIPTION This role provides support for clinical member services review assessment processes. Responsible for verifying that services...  ...teams to promote the Molina care model. Adheres to utilization management (UM) policies and procedures. Required Qualifications... 
    Hourly pay
    Work experience placement
    Work at office
    Remote work
    Shift work
    Weekend work

    Molina Healthcare

    San Francisco, CA
    3 days ago
  • A leading healthcare company is looking for a Physician Clinical Reviewer - Dermatology for a remote position. The successful candidate will review medical cases, interact with physicians, and ensure compliance with clinical guidelines. An MD/DO/MBBS degree is required... 
    Remote job
    Work from home

    Prime Therapeutics

    Salt Lake City, UT
    3 days ago