Utilization Review Nurse jobs

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UM Nurse Associate

Aetna - 2,284 reviews - City of Sunrise, FL  +2 locations
The UM Nurse Associate applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for...

Nurse Reviewer SNF

HMS - 547 reviews - Ohio
1+ year utilization review experience preferred. Nurse Reviewer SNF. Ability to medically review; Assigns case reviews by identifying the issues for review and...

SNF Nurse Reviewer

HMS - 547 reviews - Ohio
1+ year utilization review experience preferred. SNF Nurse Reviewer. Ability to medically review; Assigns case reviews by identifying the issues for review and...

Medical Review Nurse

Performant Financial Corporation - 13 reviews - San Angelo, TX
The Medical Review Nurse performs medical claims audit reviews. Strong preference for experience performing utilization review for an insurance company, Tricare...

Concurrent Review Nurse

MEDsearch - Rancho Cucamonga, CA
Two or more years of utilization management/case management in a health care delivery setting, with an emphasis on Concurrent Review and utilization management....
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Prior Authorization Nurse I

Buckeye Community Health Plan - 457 reviews - Columbus, OH 43215 (Downtown area)
Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case...

Concurrent Review Nurse II

California Health & Wellness - 457 reviews - Fresno, CA  +1 location
Participate in utilization management committees and work on special projects related to utilization management as needed....

Concurrent Review Nurse II

Trillium Community Health Plan - 457 reviews - Eugene, OR 97403 (Laurel Hill Valley area)  +1 location
Participate in utilization management committees and work on special projects related to utilization management as needed....

RN Utilization Management Nurse

Arkansas Blue Cross and Blue Shield - 25 reviews - Little Rock, AR
Job Summary The Utilization Review Nurse is accountable for clinical review to assist ABCBS members, and other contracted lines of business prior to, and during...

RN Utilization Management Exchange

Arkansas Blue Cross and Blue Shield - 25 reviews - Little Rock, AR
The Utilization Review Nurse is accountable for clinical review to assist ABCBS members, and other contracted lines of business prior to, and during inpatient...
RN - Utilization Review Specialist - 100% FTE, Day
UW Health - 57 reviews - Madison, WI
Recent experience as an inpatient utilization review nurse or UM coordinator. The Utilization Review (UR) Specialist has well-developed knowledge and skills in...
Case Manager Registered Nurse - Utilization Review ( Full Ti...
Providence Health & Services - 818 reviews - Santa Monica, CA 90407
Minimum of 3 years experience in case management, discharge planning, and/or utilization review. Current California Registered Nurse license....
Utilization Review Nurse
Mercy - 220 reviews - Chesterfield, MO
The Utilization Review Nurse is responsible for the development, implementation, coordination, and follow-up of projects related to Mercy Care Management....

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