Average salary: $93,259 /yearly
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- ...The Council of State and Territorial Epidemiologists is seeking a Clinical Utilization Review Nurse (RN) for a remote position focused on assessing healthcare services for medical necessity. Candidates must hold an active RN license in Alabama and have at least 3 years...SuggestedRemote work
Council Of State and Territorial Epidemiologists
Sacramento, CA2 days ago $88.85k
...Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established...SuggestedFull timeLOS ANGELES CARE HEALTH PLAN
Los Angeles, CA1 day ago- ...Job Description Job Description To Apply for this Job Click Here Position: UTILIZATION REVIEW RN- Case Management- SIGN ON BONUS Location: Alamogordo, NM **Onsite- In person (40 HRS) Schedule: Days Responsibilities: Meets expectations aligned...SuggestedWork at officeRelocation package
i4 Search Group
Alamogordo, NM2 days ago $46.73k - $69.03k
...RN Care Manager | Utilization Review Specialist Littlerock, WA $46,729 - $69,029 a year Join a dedicated healthcare team in the Pacific Northwest region as an RN Care Manager specializing in utilization review. This role involves coordinating care and managing service...SuggestedWork at officeMLee Healthcare Staffing and Recruiting, Inc
La Center, WA15 hours ago- A healthcare staffing firm is seeking an experienced Registered Nurse (RN) for the role of Utilization Review / Case Manager. Responsibilities include conducting utilization reviews, collaborating with interdisciplinary teams, and ensuring compliance with care plans. The...Suggested
- ...Provides support for clinical member services review assessment processes. Responsible for... ...the Molina care model. Adheres to utilization management (UM) policies and procedures.... ...education and experience. Registered Nurse (RN). License must be active and unrestricted...SuggestedWork at officeRemote work
Molina Healthcare
Long Beach, CA15 hours ago - ...Provides support for clinical member services review assessment processes. Responsible for... ...the Molina care model. • Adheres to utilization management (UM) policies and procedures.... ...education and experience. • Registered Nurse (RN). License must be active and unrestricted...SuggestedWork at officeRemote work
Molina Healthcare
United States1 day ago $41 - $64 per hour
...Job Description Job Description Utilization Review Nurse (RN) Location: Las Vegas, NV Job Type: Full-Time Pay: $41 – $64/hr (DOE) We are seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate...SuggestedFull timeLancesoft INC
Las Vegas, NV10 days ago$88.85k
...net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically necessary... ...telephonic and/or onsite admission and concurrent review, and collaborates with onsite staff, physicians,...Suggested- ...description : RN II-Case Management/ Utilization Review (CNA)Assesses appropriateness of admission status and level of care, using InterQual criteria. Provides discharge planning services, coordinating with patients, families, and community agencies. Collaborates with...SuggestedWork experience placementShift workDay shift
Windsor Healthcare Recruitment Group, Inc.
San Luis Obispo, CA3 days ago $30.5 - $67.97 per hour
...Healthcare in Mesa, Arizona is seeking a Clinical Reviewer to support medical claim reviews, ensuring... ...The ideal candidate will possess an active RN license and at least 2 years of clinical nursing experience, including utilization review and coding. This position offers a...SuggestedHourly pay$30.5 - $67.97 per hour
...Healthcare in Texas seeks a clinical support professional to review medical claims and appeals, ensuring compliance with... ...least two years of clinical nursing experience, including utilization review and active RN licenses. Responsibilities include validating claims, resolving...Suggested$30.5 - $67.97 per hour
...for medical claims and appeals. Responsibilities include reviewing medical claims, ensuring compliance with regulations,... ...2 years of clinical nursing experience, with 1 year in utilization review, and an active RN license. Effective communication, analytic skills, and...SuggestedHourly payWork at office$30.5 - $67.97 per hour
...Healthcare in Bellevue, WA seeks a clinical nurse for medical claim review and internal appeals support. Ideal candidates will have at least 2 years of clinical nursing experience and 1 year in utilization review. Responsibilities include validating medical records,...SuggestedHourly pay$30.5 - $67.97 per hour
...Omaha, Nebraska is seeking a Clinical Nurse to support medical claim and appeals review activities. This role requires at least 2 years of clinical nursing experience, with a focus on utilization review and medical claims. An active Registered Nurse license is mandatory....SuggestedHourly pay$30.5 - $67.97 per hour
...hiring a Clinical Nurse for medical claims and internal appeals reviews. The ideal candidate will have at least 2 years of clinical nursing experience, including utilization review, and must possess an active RN license. Responsibilities include facilitating medical claims...Hourly pay$30.5 - $67.97 per hour
...is seeking an experienced Registered Nurse to conduct clinical reviews of medical claims and appeals, ensuring adherence to... ...appropriateness of services and resolving complaints regarding utilization management. The position offers a competitive hourly pay range...Hourly pay- Molina Healthcare in Fort Worth, Texas, is seeking a detail-oriented Registered Nurse for clinical support in medical claims review and utilization management. The role requires at least 2 years of nursing experience, including utilization review, coding expertise, and...Hourly pay
- ...Nurse with at least 2 years of nursing experience, including utilization and medical claims review. The role entails facilitating medical reviews and... ...support and training to peers. Candidates must hold an active RN license in South Carolina, along with understanding of...
$30.5 - $67.97 per hour
Molina Healthcare in Albuquerque, NM is looking for a Clinical Reviewer to support medical claim and internal appeals review... ...have at least 2 years of clinical nursing experience, including utilization review, and must possess an active Registered Nurse license. Responsibilities...Hourly pay$30.5 - $67.97 per hour
...Nurse to support medical claims and appeals review in Miami, Florida. The role involves... ...ensure compliance with regulations, resolving utilization management issues, and acting as a... ...inquiries. Candidates must have an active RN license and at least 2 years of clinical...Hourly pay- Council of State and Territorial Epidemiologists is hiring a Clinical Utilization Review Nurse (RN) to work remotely while assessing the medical necessity of healthcare services. This role requires an active RN license in Alabama and a minimum of 3 years direct patient...Remote jobWork from home
$30.5 - $67.97 per hour
Molina Healthcare is seeking a Clinical Reviewer in Cincinnati, Ohio. This role requires at... ...clinical nursing experience and a valid RN license. Responsibilities include medical... ...regulations, resolving complaints pertaining to utilization management, and identifying quality of...Hourly pay$30.5 - $67.97 per hour
...in Des Moines, Iowa, seeks an experienced Registered Nurse for clinical claims review. Candidates should have at least 2 years of clinical nursing experience, including skills in utilization review and coding. The role involves reviewing medical claims and managing escalated...Hourly pay$102,000 per week
LifeBridge Health seeks a Utilization Review Nurse RN to evaluate medical necessity and appropriate level of care across our continuum. In this role, you will conduct concurrent and retrospective reviews, apply evidence-based criteria, and collaborate with physicians, payers...LifeBridge Health
Baltimore, MD7 days ago- A healthcare organization is seeking Clinical Utilization Review Nurses (RN) for a remote position to assess healthcare services in line with Alabama Medicaid requirements. Candidates must possess a BA/BS in Nursing, an active RN license in Alabama, and at least 3 years...Remote job
- The Council of State and Territorial Epidemiologists is seeking Clinical Utilization Review Nurses (RN) in Alabama to assess healthcare services' medical necessity. This full-time remote role involves applying Medicaid guidelines, completing reviews, and coordinating with...Remote jobFull timeFlexible hours
$40.12 - $62.19 per hour
...Utilization Review Nurse RN - Grace Medical Center ~ Baltimore, MD ~GRACE MEDICAL CENTER ~Part-time - Weekends - Day shift - 8:00am-4:30pm ~RN OTHER ~96385 ~$40.12-$62.19 Experience based ~ Posted: April 28, 2026 Apply Now Save Job Saved...Part timeShift workWeekend workDay shift$65.5k - $96.89k
...R1 RCM in Salt Lake City is seeking a Utilization Review Specialist to be part of the Physician Advisory Team. This role involves performing initial... .... Candidates must possess a Bachelor's Degree, a current RN license, and at least 3 years of clinical nursing experience....R1 RCM
Salt Lake City, UT2 days ago$45.9 - $71.4 per hour
...Description Utilization Review RN - Remote. The RN Care Coord‑Qual Med Mgmt will provide administration of medical management programs that include prior authorization, concurrent hospital and skilled nursing review, appeals and grievance, delegation, medical policy development...Hourly payLocal areaRemote workProvidence Health & Service
Renton, WA1 day ago
