Utilization Review Nurse jobs

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Clinical Care Manager Registered Nurse (RN) or LMSW - MI Dua...
Aetna 481 reviews - Kalamazoo, MI
Nursing/Registered Nurse is required if RN. Click here to review the benefits associated with this position....
Sponsored by Aetna - 3 days ago
Appeals Nurse Reviewer - Managed Care
Florida Hospital Tampa 28 reviews - Tampa, FL
The Utilization Appeals Nurse will review each case identified/referred for appeal based on Milliman Care Guidelines (MCG), Inter....
Sponsored by American Hospital Association - 27 days ago
Utilization Review Nurse (Medical/Behavioral Health – Psychi...
The HSC Health Care System - Washington, DC
Certification in utilization review preferred. The Utilization Review (UR) Nurse is responsible for the clinical review of pediatric and young adult members for...
Sponsored by The HSC Health Care System - 15 days ago
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Registered Nurse (Clinical Documentation Improvement Special...

Department of Veterans Affairs 972 reviews - Murfreesboro, TN
The RN possesses up-to-date clinical knowledge to efficiently and concurrently review medical records, identify opportunities for improved documentation, and...

Nurse Reviewer - Temporary

HMS 379 reviews - East Windsor, NJ
Utilization review or medical abstraction experience necessary. Nurse Reviewer - Temporary. Is responsible for performing clinical reviews of medical...

Appeals Nurse

Ascend Management Innovations - Franklin, TN
Prior utilization review experience in a healthcare setting is preferred. Conducts utilization review of medical assessor documentation related to level of care...
Easily apply

Utilization Management Registered Nurse (UM)

Stanwell Health - Hudson, OH
Perform telephonic and electronic review to:. Complete predeterminations and retrospective reviews as requested....
Easily apply


Brigham & Women's Faulkner Hospital 9 reviews - Boston, MA
3 year of Utilization Review and Case Management experience required. Case Review Coordinator, 40 hrs. Current Registration as a Licensed Nurse in the State of...

Care Coordinator

Premera Blue Cross 72 reviews - Mountlake Terrace, WA - +1 location
Utilization Management experience. Inpatient review, concurrent review, benefit advisory/prior authorization, retrospective, out of network, and appropriateness...

Utilization Management Rep I - Indianapolis, IN - 6/15

Anthem, Inc. 582 reviews - Indianapolis, IN - +1 location
Refers cases requiring clinical review to a Nurse reviewer. Utilization Management Rep I. Responsible for coordinating cases for precertification and prior...

Utilization Management Technician

AmeriHealth Caritas 59 reviews - Philadelphia, PA
Supports Utilization Management nurses by generating and assigning cases for review. Accurately answers questions regarding Utilization Management requirements...

Utilization Management and Review Specialist

OSF Healthcare 8 reviews - Peoria, IL
Performs Utilization Management and Review (UMR) activities. Evaluates patient care and activities against objective criteria in an effort to take a proactive...


Houston Methodist 417 reviews - Baytown, TX 77521
Knowledge of quality or utilization review and principles required. 1 to 3 years' quality or utilization review background preferred....
RN/Healthy @ Home/Salary
Carolinas HealthCare System 152 reviews - Charlotte, NC
Reviews patient records monthly and participates in utilization and compliance reviews and substantiates in writing any deviation from care plan with...
Sponsored by Carolinas HealthCare System - 7 days ago
Utilization Management Coordinator I-15064
North East Medical Services 4 reviews - San Francisco, CA
The Utilization Management Coordinator I functions under the direct supervision of a physician or Registered Nurse performing utilization management and care...
Sponsored by North East Medical Services - 30+ days ago
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The HSC Health Care System offers a comprehensive approach to caring, serving, and empowering individuals with disabilities.