Nurse Utilization Review jobs in Pittsburgh, PA

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Nurse Clinician RN (Cross Functional)
Express Scripts 924 reviews - Warrendale, PA
Previous clinical criteria review experience preferred; The Nurse Clinician – RN is responsible for reviewing escalated clinical criteria reviews for providers,...
Sponsored by Express Scripts - 17 days ago
Telephonic Care Advocate. Work from Home.
UnitedHealth Group 1,880 reviews - Pittsburgh, PA
· Managed care or utilization review experience. · Conduct focused utilization reviews effectively and efficiently; Or registered psychiatric nurse....
Sponsored by UnitedHealth Group - 17 days ago
RN Hospice Case Manager-1 Year RN Exp
Bethany Hospice - Pittsburgh, PA
REGISTERED NURSE CASE MANAGER. Demonstrates expertise in utilization of team members including volunteers and community resources....
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Sponsored by Bethany Hospice - 30+ days ago

Preservice Review RN - Pittsburgh, PA

UnitedHealth Group 1,880 reviews - Pittsburgh, PA
Perform utilization and concurrent review using Milliman criteria. As a Preservice Review Nurse your duties will include:....

Registered Nurse -RN- UM Nurse Consultant

Aetna 450 reviews - Pittsburgh, PA 15219 (Middle Hill area)
Utilization management preferred. You will conduct Utilization Review and Discharge Planning for members admitted to an acute facility....

Clinical Appeals Coordinator

UPMC 263 reviews - Pittsburgh, PA
Two years of Health Insurance experience as a Registered Nurse in a Utilization Management/Medical Management role strongly preferred....

Clinical Auditor/Analyst

UPMC 263 reviews - Pittsburgh, PA
Responsibilities may involve multiple line of business focused reviews, or ad hoc reviews as needed; Prepayment review of high dollar claims, and prepayment...

Registered Nurse (RN) - Utilization Management Nurse Consult...

Aetna 450 reviews - Pittsburgh, PA 15220
Conduct Utilization Review and Discharge Planning for members admitted to an acute facility. Nursing/Registered Nurse (RN) is required....

Telephonic Care Advocate. Work from Home.

UnitedHealth Group 1,880 reviews - Pittsburgh, PA
· Managed care or utilization review experience. · Conduct focused utilization reviews effectively and efficiently; Or registered psychiatric nurse....

Associate Care Management Coordinator

Highmark Health 5 reviews - Pittsburgh, PA
Document, process and route requests for services to the nurse reviewer and other departments based on documentation procedures, including review type, clinical...

Supervisor, Medical Management & Policy Clinical

Highmark Health 5 reviews - Pittsburgh, PA
Review and provide input into the oversight of policies and procedures to support regulatory requirements related to Utilization Review....

Case Manager II (Pool)

HealthSouth Corporation - Sewickley, PA - +1 location
The CM II performs ongoing utilization review and acts as a liaison to the payor while assuring that cost effective treatment is provided by the team....

Care Manager - Utilization Management RN

Highmark Health 5 reviews - Pittsburgh, PA
1 year of Utilization Management experience. Certification in Utilization Management or a related field....
Preservice Review RN - Pittsburgh, PA
UnitedHealth Group 1,880 reviews - Pittsburgh, PA
Perform utilization and concurrent review using Milliman criteria. As a Preservice Review Nurse your duties will include:....
Sponsored by UnitedHealth Group - 8 days ago
Registered Nurse Telephonic Triage
Maxim Healthcare 719 reviews - Sewickley, PA
Maxim Healthcare seeking energetic RN's for new Telephonic, Utilization Review positions with competitive pay....
Sponsored by NurseJobsNationwide.com - 6 days ago

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Company with Nurse Utilization Review jobs
924 reviews
Express Scripts is a Fortune 25 company and is the largest pharmacy benefit manager in the U.S.