Utilization Review Nurse jobs

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Clinical Resource Coordinator
Washington Hospital Center 108 reviews - Washington, DC
concurrent medical record review of selected patient... and spreadsheets are required. Knowledge of utilization management, issues and mechanisms, managed care...
Sponsored by Washington Hospital Center - 13 days ago
Registered Nurse (RN) - Medicaid Prior Auth Utilization Nurs...
Aetna 343 reviews - Phoenix, AZ
Consultant / Prior Authorization Nurse Conducts prospective reviews of authorization requests, including... all aspects of the utilization/benefit management...
Sponsored by Aetna - 6 days ago

On-site Nurse Case Manager - Atlanta, GA

UnitedHealth Group 1,474 reviews - Atlanta, GA
RN, Registered Nurse, Case Manager, Managed Care, Utilization Review, CCM, Discharge Planning, Atlanta, Georgia, GA....
5 days ago - save job - email - more...

Preservice Review RN Optum Medical Network - Las Vegas, NV

UnitedHealth Group 1,474 reviews - Las Vegas, NV
The Preservice Review Nurse is responsible for reviewing requests received from providers, using approved protocols and criteria (per United....
3 days ago - save job - email - more...

Clinical Appeals RN

UnitedHealth Group 1,474 reviews - Houston, TX
utilization review, UR, utilization management, UM, TPA, managed care, insurance, concurrent review, appeals, provider appeals, member appeals, RN, Registered...
1 day ago - save job - email - more...

Primary Nurse Case Admin I

Blue Cross Blue Shield 1,196 reviews - Downers Grove, IL
This position is responsible for performing all functions of Utilization Management (UM), Case Management (CM) and Disease Management (DM) and is a single...
HCSC - 4 days ago - save job - email - more...

RN Clinical Consultant - NY/NJ

Cigna 680 reviews - Albany, NY - +1 location
Providing consultative support to sales for identified non-standard process requests including recommendation for Exception Review Committee (ERC) review....
4 days ago - save job - email - more...

Utilization Management RN - Care Management

Legacy Health System 11 reviews - Portland, OR
by performing admission and continued stay reviews as per government and commercial payor contractual requirements, to include the JCAHO Utilization Review... $34.11 - $49.62 an hour
20 days ago - save job - email - more...

Utilization Management Nurse RN, WellMed, San Antonio, TX (5...

WellMed Medical Mgmt, Inc - San Antonio, TX
May provide guidance and coaching to other utilization review nurses and participate in the orientation of newly hired utilization nurses....
WellMed Medical Group - 4 days ago - save job - email - more...

UM/Concurrent Review Nurse

Catholic Health Initiatives 95 reviews - Federal Way, WA
The primary role of the Utilization Management/Concurrent Review Nurse is to review and monitor members’ utilization of health care services with the goal of...
16 hours ago - save job - email - more...


MetroHealth 6 reviews - Cleveland, OH
Under the direction of the Chief Compliance Officer reviews medical records for medical necessity requirements in conjunction with Provider Advisors....
8 days ago - save job - email - more...

Registered Nurse w/ Medicaid Exp.

Logistics Integration Solutions - Warwick, RI
Our organization is looking for an experienced Registered Nurse w/ Medicaid Exp. for a 8+ months contract position in the Warwick, RI....
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1 day ago - save job - email - more...
Admissions Nurse
Presbyterian Homes and Services 62 reviews - Brooklyn Center, MN
planning; and utilization review for all payer types, including Medicare, Managed Care and other third party payer systems. Qualifications Registered nurse...
Sponsored by Presbyterian Homes and Services - 21 hours ago
Utilization Review Nurse - Sinai
Sinai Hospital of Baltimore 19 reviews - Baltimore, MD
Utilization Review Nurse - Sinai Requisition Number... Nurse Practice Act; Critical thinking skills; Interqual and Milliman Utilization Review Criteria; Three to...
Sponsored by LifeBridge - 6 days ago
RN Case Manager (part time)
Blake Medical Center 11 reviews - Bradenton, FL
accordance with Utilization Plan using ISD criteria, and performs concurrent stay reviews at least every... and decrease resource utilization. Identifies and...
Sponsored by HCA West Florida - 6 days ago
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Company with Utilization Review Nurse jobs
62 reviews
Presbyterian Homes and Services is a non-profit organization providing high quality housing, care, and service options for older adults.
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