Average salary: $234,742 /yearly
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$103 per hour
...Senior Utilization Review Specialist The Senior Utilization Review Specialist collaborates with the healthcare team in the management and... ...and documentation requirements Education/Advisory a. Physician Educator b. Provide formal educational lectures and engage in...SuggestedHourly payDaily paidFull timeContract workPart timeFor contractorsApprenticeshipWork experience placementShift workNight shiftWeekend workAfternoon shift- ...to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality... ...the exam room for all patients. What You’ll Be Doing Utilization Review & Clinical Determinations Complete timely review of healthcare...SuggestedBi-weekly payFull timeTemporary workFor contractorsLocal areaRemote workWork from home
Guidehealth
Peoria, IL3 days ago $43.29 - $76.06 per hour
...assessment and planning, coordination of care, resource utilization management and/ or review, discharge planning, documentation of interventions,... ...diagnostics and treatment, outpatient health centers, physician groups and clinics, outreach programs, and hospice and...SuggestedMinimum wageFull timeLocal areaRelocationRelocation packageShift workDay shift1 day per weekProvidence Health and Services
Eagle River, AK3 days ago- ...Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are currently seeking Board-... ...Workers’ Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-clinical...SuggestedPrice workExtra incomeFor contractorsRemote workFlexible hours
Dane Street
United States3 days ago $90.87 - $154.33 per hour
...A healthcare organization seeks a Physician Clinical Reviewer in Gastroenterology to provide medical review for service requests remotely. Candidates... ...to impact patient care and work collaboratively in a utilization management team while enjoying a competitive salary...SuggestedRemote workPrime Therapeutics
Saint Paul, MN2 days ago$250k
...A national healthcare solutions provider is seeking a Utilization Review Medical Director to conduct clinical reviews of Durable Medical Equipment requests. This full-time role emphasizes adherence to workflow timelines and requires an MD or DO degree along with board...SuggestedFull timeRemote workIntegra Partners
Troy, MI2 days ago$223.8k - $313.1k
...Director relies on medical background and reviews health claims. The Medical Director... ...factors. Join a collaborative team of physicians who bring clinical expertise to medical... ...Physicians, and Physicians with Inpatient or Utilization Review Experience Role Overview Provide...SuggestedFull timeTemporary workApprenticeshipRemote workMonday to FridayFlexible hoursShift workWeekend workHumana
Richmond, VA2 days ago- ...Utilization Review Medical Director - Remote Medical Review Institute of America (MRIoA) is a market leader in utilization management and... ...solutions. We are seeking a full‑time, remote Medical Director (Physician Reviewer) to evaluate clinical service requests and...SuggestedFull timePart timeRemote workShift workWeekend work
Medical Review Institute
Los Angeles, CA3 days ago - ...is seeking an experienced Medical Director to conduct clinical reviews and guide decision-making in inpatient care. The role... ...of clinical experience, with a focus on hospital medicine and utilization review. Join a distinguished team to impact patient outcomes while...SuggestedRemote work
Humana
Columbus, OH2 days ago - ...A healthcare company is looking for a Medical Director to review inpatient medical records and determine medical necessity based on... ...five years of clinical experience and a solid understanding of utilization management. Strong communication skills and the ability to...SuggestedRemote work
Humana
Saint Paul, MN1 day ago - ...A leading healthcare company in Washington, D.C. is seeking a Medical Director to oversee inpatient medical necessity reviews and utilization management. This role requires strong analytical and communication skills, as well as 5+ years of clinical experience post-residency...SuggestedRemote work
Humana
Washington DC3 days ago - ...their collaborative team. The role involves conducting clinical reviews of inpatient medical records to ensure appropriate care.... ...position provides the opportunity to work within a structured team, utilizing strong analytical skills to make informed decisions. Benefits include...SuggestedRemote work
Humana
Montgomery, AL1 day ago - ...Director to conduct inpatient medical necessity reviews while collaborating with healthcare providers. This role requires a physician with at least 5 years of post-residency... ...performing clinical reviews, providing utilization management determinations, and ensuring compliance...SuggestedRemote workMonday to Friday
Humana, Inc.
Nashville, TN3 days ago - ...A health insurance startup is looking for an experienced Medical Director to oversee utilization reviews and prior authorizations. This remote position demands a strong clinical background with a doctorate in medicine and board certification. The ideal candidate will have...SuggestedRemote workFlexible hours
VALID8 Financial
Austin, TX8 hours ago - ...A healthcare organization is seeking Board-Certified physicians in Oncology for a flexible, remote utilization review role. This position requires a Medical Degree (MD or DO) with a current license in Florida, Minnesota, or Oregon, and an active Board Certification in...SuggestedRemote workFlexible hours
Medical Review Institute
Dallas, TX3 days ago - ...A growing healthcare company is seeking an entry-level Utilization Review Nurse for a fully remote position. Responsibilities include performing clinical reviews, assisting in quality improvement projects, and interacting with healthcare providers. Candidates must have...Remote work
TurningPoint Healthcare Solutions
Florida, NY2 days ago - ...The Utilization Review (UR) Clinical Lead is responsible for overseeing and guiding the utilization review process to ensure medical necessity, regulatory compliance, and appropriate use of healthcare resources. This role provides clinical leadership to the UR team, supports...Local area
Hurc LLC
Short Hills, NJ4 days ago $54 - $66 per hour
...A prominent healthcare staffing agency is seeking a Utilization Review Nurse in Sacramento, CA, responsible for managing the daily operations of the UM Pre-Authorization team. The ideal candidate will ensure accurate processing of referral requests, maintain regulatory...Pacific Staffing
Sacramento, CA3 days ago$223.8k - $313.1k
...company is seeking a Medical Director to provide expert clinical reviews and advance patient outcomes. This remote position emphasizes... ...abilities. Join a dedicated team focused on effective utilization management while enjoying a competitive compensation range of...Remote workHumana
Springfield, IL3 days ago$90.87 - $154.33 per hour
...A healthcare company is seeking a Physician Clinical Reviewer - Dermatology to join their utilization management team. This remote position involves reviewing medical service requests, interacting with physicians, and providing clinical justifications for appeals. The...Remote workPrime Therapeutics
Austin, TX3 days ago- ...A leading pharmacy benefit management company is seeking a Physician Clinical Reviewer for a remote position. You will play a crucial role in the utilization management team by providing timely medical reviews of service requests, interacting routinely with physicians...Remote work
Prime Therapeutics
Montgomery, AL3 days ago - ...A healthcare organization is seeking a Physician Clinical Reviewer specializing in Dermatology to join their utilization management team. This remote role involves reviewing medical service requests, collaborating with healthcare professionals, and ensuring compliance...Remote work
Prime Therapeutics
Baton Rouge, LA3 days ago - ...Utilization Review Specialist Collin Springs-Changes Plano is part of Lifepoint Health, a diversified healthcare delivery network with... ...organizations, external reviews, and other payers. Communicate with physicians to schedule peer to peer reviews. Accurately report...Temporary workPart timeRelief
- ...Director of Utilization Review Under the direction of the Director of Utilization Review, the Specialist will coordinate Medicaid Managed Care authorizations and re-authorizations for clients receiving behavioral healthcare services from Odyssey House's Part 820 residential...Temporary workFlexible hours
- ...Job Description Job Summary: Key Job Responsibilities The Post-Procedure Utilization Management (UM) Registered Nurse is responsible for performing real-time utilization review for surgical and procedural patients immediately following procedures. This role ensures...Immediate startNight shift
Cedars-Sinai
Los Angeles, CA5 days ago - ...Emory Healthcare Utilization Review Specialist Be inspired. Be rewarded. Belong. At Emory Healthcare. At Emory Healthcare we fuel your... ...efforts with the Case Management Department, Revenue Cycle, Physician Advisors, and other required departments. Additional...Work at officeRemote work
- ...A leading healthcare analytics firm is seeking a Registered Nurse for a remote role focused on utilization review and clinical determinations. The position requires strong communication skills, 5+ years of varied healthcare experience, and an active RN license in Illinois...Remote work
Guidehealth
Chicago, IL3 days ago - ...A healthcare technology company based in Illinois is seeking an experienced Registered Nurse for a clinical role focusing on utilization review and care coordination. The ideal candidate will have 5+ years in healthcare, a strong understanding of managed care processes...Remote work
Guidehealth
Rockford, IL3 days ago - ...A healthcare organization is looking for a Utilization Management RN in Mission Hills, California, to provide prospective, retrospective, and concurrent reviews for ministries. Candidates should have strong clinical skills, a nursing degree, and California RN license....Remote work
Providence Service
Mission Hills, CA1 day ago - ...A leading healthcare provider is looking for an experienced Registered Nurse in Peoria, Illinois. The role focuses on utilization review, clinical consultation, and effective patient support within a fully remote setting. Candidates should have an active Illinois RN license...Remote workWork from home
Guidehealth
Peoria, IL3 days ago
