Average salary: $234,742 /yearly

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  • The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical records for the patient population and Hackensack UMC. These include but are not limited to utilization review... 
    Suggested
    Daily paid
    Weekend work

    Hackensack Meridian Health Inc.

    Hackensack, NJ
    1 day ago
  • A leading Independent Review Organization is looking for Board-Certified Psychiatrists for a fully remote role. This position involves conducting utilization reviews and provides flexible scheduling along with supplemental income. Responsibilities include reviewing medical... 
    Suggested
    Remote job
    Extra income
    Flexible hours

    Dane Street

    New York, NY
    3 days ago
  • $264k - $277k

     ...leading health insurance provider is seeking a fully remote Physician Reviewer to assess care requests for compliance with medical...  ...requires board certification as an MD or DO, and 1+ years of utilization review experience. Candidates should have 5-6+ years of clinical... 
    Suggested
    Remote job
    Flexible hours

    Insight Global

    Florida, NY
    1 day ago
  •  ...with standards. The ideal candidate is a board-certified MD or DO with at least 6 years of clinical experience and 1 year in utilization review. Responsibilities include timely medical reviews, clinical determinations, and accurate documentation. Licensure in Florida or... 
    Suggested
    Full time

    Medix™

    Florida, NY
    1 day ago
  • $172.9k - $230.5k

     ...Overview Oversees the utilization of medical care and treatment of VNS MSO members and provides direction and guidance to the staff to...  ...Management (UM), initial and internal appeals decisions. This includes review of clinical information provided against evidence-based... 
    Suggested
    Work experience placement
    Remote work
    Flexible hours

    VNS Health

    New York, NY
    1 day ago
  • $211.2k - $277.2k

     ...Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the... 
    Suggested
    Full time
    Local area
    Remote work
    Work from home
    Home office
    Weekend work

    Oscar Health

    New York, NY
    2 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... 
    Suggested
    Price work
    Extra income
    For contractors
    Remote work
    Flexible hours

    Dane Street

    United States
    18 hours 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... 
    Suggested
    Minimum wage
    Full time
    Local area
    Relocation
    Relocation package
    Shift work
    Day shift
    1 day per week

    Providence Health and Services

    Chugiak, AK
    18 hours ago
  • Inova Fairfax Medical Campus is looking for a dedicated physician advisor to join the Utilization Review Advisor team. This role will be full‑time and on‑site. It is also available as a remote/hybrid position. The Utilization Review Physician Advisor (Advisor) conducts... 
    Suggested
    Full time
    Remote work
    Flexible hours

    Inova Health System

    Fairfax, VA
    4 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... 
    Suggested
    Local area

    Hurc LLC

    Short Hills, NJ
    1 day ago
  • A health insurance company is seeking a Physician Reviewer to join their Utilization Management team. This remote role involves determining the medical appropriateness of services by reviewing clinical information and adhering to evidence-based guidelines. Candidates must... 
    Suggested
    Remote job

    Oscar Health Insurance

    New York, NY
    2 days ago
  • A leading health insurance company is hiring a remote Physician Reviewer to join their Utilization Management team. This role involves determining the medical appropriateness of services based on clinical information and evidence-based guidelines. Candidates should have... 
    Suggested
    Remote job

    Oscar Health

    New York, NY
    2 days ago
  • $174.07k - $374.92k

     ...bigger - helping to simplify health care one person, one family and one community at a time. Role Description The Utilization Management Physician Reviewer ensures timely and clinically sound coverage determinations for inpatient and outpatient services using evidence-... 
    Suggested
    Hourly pay
    Full time
    Local area
    Flexible hours
    Weekend work

    Chicagoderm

    Waukegan, IL
    1 day ago
  • $172.9k - $230.5k

     ...nonprofit healthcare organization in New York is seeking an experienced medical professional to oversee utilization management for members. The role includes reviewing clinical information, ensuring compliance with guidelines, and contributing to quality care... 
    Suggested

    VNS Health

    New York, NY
    4 days ago
  • $50 per hour

    A healthcare provider in California is seeking a full-time Assistant DON/Utilization Review Nurse. The role involves ensuring adherence to the hospital’s utilization review plan and overseeing nursing standards. Candidates must possess a State of Nevada Nursing License... 
    Suggested
    Full time

    Mt. Grant General Hospital

    Hawthorne, CA
    18 hours ago
  •  ...The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization...  ...activities. The Medical Director functions as the primary physician advisor for the hospital and supervises other Physician... 
    Work experience placement

    Memorial Healthcare System

    Hollywood, FL
    2 days ago
  • A leading healthcare provider is searching for a Medical Director to support the Medical Management staff with utilization reviews, appeals, and pharmacy oversight. This role requires an MD or DO with at least 3-5 years of clinical experience and a current medical license... 
    Remote job
    Full time
    Work from home

    Hispanic Alliance for Career Enhancement

    Chicago, IL
    4 days ago
  •  ...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... 
    Immediate start
    Night shift

    Cedars-Sinai

    Los Angeles, CA
    2 days ago
  •  ...Summary of Essential Duties: The Utilization Management (UM) Registered Nurse –...  ...Denials supports post-discharge clinical reviews for Medicare Short Stay cases and assists...  ...timelines. The UM RN collaborates with physicians, revenue integrity, and payer partners... 

    Cedars-Sinai

    Los Angeles, CA
    2 days ago
  • A leading Independent Review Organization is looking for Board-Certified Orthopedic Spine...  ...for a fully remote role performing utilization reviews. Candidates must have an active...  ...offers flexibility in scheduling and allows physicians to earn supplemental income without patient... 
    Remote job
    Extra income

    Dane Street

    New York, NY
    1 day ago
  • Rheumatology (MD/DO) Utilization Review - Remote Contract (1099) Apply for this independent contractor position with Medical Review Institute...  .... The Opportunity We are seeking board‑certified physicians in rheumatology to conduct independent utilization reviews.... 
    Remote job
    Contract work
    For contractors
    Flexible hours

    Medical Review Institute of America

    Los Angeles, CA
    4 days ago
  •  ...Board-Certified Orthopedic Spine Surgeons for a fully remote, non-clinical role in Utilization Review. This opportunity offers flexibility and supplemental income, allowing physicians to provide evidence-based opinions on treatment requests without direct patient interaction... 
    Remote job
    Extra income

    Dane Street, LLC

    New York, NY
    3 days ago
  •  ...elevate outcomes, and love your Mondays as the Nurse Director Utilization Review and Case Management at an award winning hospital in the Bay...  ..., and readmission reduction—uniting social work, nursing, physicians, and ancillary teams to elevate every transition of care at... 
    Remote work
    Weekend work

    Clinical Management Consultants

    Berkeley, CA
    2 days ago
  • $30.5 - $59.47 per hour

     ...support medical claims and internal appeals. Responsibilities include facilitating clinical reviews, verifying medical records, and resolving complaints regarding utilization management. Ideal candidates will have at least 2 years of clinical experience, strong communication... 
    Hourly pay
    Full time

    Molina Healthcare

    Chicago, IL
    1 day ago
  • A healthcare organization in the SF Bay Area is seeking an experienced Interim UM Assistant Nurse Manager to lead utilization review. This full-time role requires a steady, clinically strong leader who will stabilize and support staff while the hospital conducts a permanent... 
    Permanent employment
    Full time
    Interim role

    On Deck Healthcare

    San Francisco, CA
    1 day ago
  • $29.05 - $67.97 per hour

     ..., is seeking a clinical professional to support medical claim reviews and internal appeals. This role ensures compliance with federal...  ...should be Registered Nurses with relevant experience in utilization review and medical claims, excellent analytical and organizational... 
    Hourly pay

    Molina Healthcare

    Fort Worth, TX
    3 days ago
  • $36.7 - $69.38 per hour

     ...currently seeking a Staff Nurse to join our Utilization Management department for the Emergency...  ...RESPONSIBILITIES: The Utilization Review (UR) Registered Nurse is responsible for...  ...services. Initiates communication with physicians and payers to resolve authorization... 
    Temporary work
    Shift work
    Weekend work
    Afternoon shift

    Hennepin County Medical Center

    Minneapolis, MN
    18 hours ago
  •  ...currently seeking a Staff Nurse to join our Utilization Management department for the/Emergency...  ...RESPONSIBILITIES: The Utilization Review (UR) Registered Nurse is responsible for...  ...services. Initiates communication with physicians and payers to resolve authorization... 
    Shift work
    Weekend work
    Afternoon shift

    Minnesota Visiting Nurse Agency

    Minneapolis, MN
    4 days ago
  • $685 - $700 per day

    Interim Assistant Nurse Manager, Utilization Review/Discharge Planning Healthcare Executive Placements, Inc. (HCEPInc) is seeking an Interim...  .... Oversee discharge planning activities, coordinating with physicians, nurses, social workers, and community resources to ensure... 
    Daily paid
    Full time
    Contract work
    Interim role
    Monday to Friday

    Azad Technology Partners

    Vancouver, WA
    4 days ago
  • A healthcare organization seeks Clinical Reviewer Unit Physicians to adjudicate coverage requests using professional standards. Responsibilities include conducting reviews, managing appeals, and consulting with external systems. Candidates must have a medical degree, 3... 

    Kaiser Permanente - Washington Permanente Medical Group (WPM...

    Renton, WA
    1 day ago