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- A leading medical review organization is seeking Board‑Certified physicians in Pediatric Hematology Oncology for flexible, remote Utilization Reviews. This role requires conducting independent reviews of pediatric cases, engaging in peer-to-peer discussions, and ensuring...SuggestedRemote jobPart timeFlexible hours
- 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 and maintaining...SuggestedLocal 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- Overview Avalon Health Care Management is hiring a Case Manager of Utilization Management and Authorizations to join our team. This role... ...by managing authorizations, utilization management, concurrent review, and payor coordination while ensuring smooth transitions of...SuggestedFull timeContract workTemporary work
$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...SuggestedHourly payFull timePart timeWork at officeFlexible hoursWeekend work- A leading healthcare provider is seeking a Utilization Review Coordinator to manage patient care and ensure safety for youth. Candidates should have a background in nursing, social work, or psychology, along with psychiatric experience in chart analysis and utilization...SuggestedFlexible 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-...SuggestedContract 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...Suggested
- Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Required Qualifications Nursing school graduate. California Registered Nurse License upon...SuggestedWork at officeLocal area
- Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Qualifications Nursing school graduate. California Registered Nurse License upon hire. 3...SuggestedWork at office
$41.14 - $61.2 per hour
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical guardian of healthcare efficiency and... ...resource utilization. Every day, you will meticulously review medical records, authorize services, and prepare cases for physician...Suggested- 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
$71.61k - $111k
Utilization Review Nurse - Albany Medical Center Overview Responsible for utilization management, quality screening, and delay management for assigned patients. Department/Unit Care Management/Social Work Work Shift Day (United States of America) Salary Range $71,6...SuggestedFull timeShift work- 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
- ...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
$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...Work at officeLocal areaFlexible hours$39 - $41 per hour
Job Title: Utilization Review Nurse Location: United States Job Type: Contract Expected Hours per Week: 40 hours per week Schedule: Monday-Friday, 9:00 AM - 5:00 PM, Remote. Pay Range: $39-41 per hour We’re seeking an experienced Registered Nurse to support Utilization...Hourly payContract workWork at officeRemote workMonday to Friday$35.62 - $52.99 per hour
Job Summary and Responsibilities As our Utilization Review LVN, your focus will be to provide high quality, cost-effective care which will enable patients to achieve maximum medical improvement while receiving care deemed medically necessary. The LVN assists in determining...Contract work$71.61k - $111k
...America) Salary Range: $71,612.39 - $110,999.20 Responsibilities Utilization management and quality screening for assigned patients. Delay... ...proper use of MCG and documentation requirements through case review and inter‑rater reliability studies. Collaborate with the...Remote workShift work- ...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...
- ...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...Temporary workCurrently hiringFlexible hours
- ...expanding access to our unique model of care across the United States. NeuroPsychiatric Hospital of Indianapolis is looking for a Utilization Review Coordinator to coordinate patients’ services across the continuum of care by promoting effective utilization, monitoring...Work at office
- 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...Full 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...Full timeRemote work
- Reviews patient admissions for medical necessity, appropriate resource utilization, and compliance with payer guidelines. Analyzes medical records to ensure care meets established clinical and regulatory standards. Requirements: Education/Experience: Graduate of an accredited...Work at office
- What We're Looking For We have openings in our Omaha, Nebraska office for Utilization Review Nurses. The Utilization Review Nurse ensures all aspects of an injured worker’s treatment are effective, efficient, and in accordance with applicable legal requirements. This is...Permanent employmentFull timeWork at officeWork from home2 days per week
$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- 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...
- 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
$41 - $45.5 per hour
...supports members through clinical assessments, health education, and utilization management. Key Responsibilities: Perform clinical... ...outcomes. Conduct prospective, concurrent, and retrospective reviews for inpatient, rehab, referrals, and select outpatient services...Remote job