Nurse Utilization Review jobs in Pittsburgh, PA

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Registered Nurse Telephonic Triage - Utilization Review
Maxim Healthcare Services 762 reviews - Pittsburgh, PA
2-4 years of recent working RN utilization review or case management experience is required. Current Registered Nurse License for the state in which the nurse...
Sponsored by Maxim Healthcare Services - 30+ days ago
Registered Nurse - RN - Telephonic
Maxim Healthcare Services 762 reviews - Pittsburgh, PA
Participate in Quality Assurance and Utilization review activities, as directed. Follow State/Country mandated guidelines for the nurse case management programs...
Sponsored by Maxim Healthcare Services - 30+ days ago

Clinical Appeals Coordinator

UPMC 272 reviews - Pittsburgh, PA
Two years of Health Insurance experience as a Registered Nurse in a Utilization Management/Medical Management role strongly preferred....

DRG Specialist II

UPMC 272 reviews - Pittsburgh, PA
OR Registered Nurse. OR Certified Registered Nurse Practitioner. The DRG Specialist II reviews clinical documentation within the medical record to ensure that...

Triage Nurse

CorVel 23 reviews - Pittsburgh, PA
Strong cost containment background, such as utilization review or managed care also useful. Triage Nurse – Multiple Pittsburgh Area Locations – Unique...

Nurse Supervisor - Cranberry Twnship, PA

RestorixHealth 7 reviews - Township of Cranberry, PA
Registered Nurse, Physician Assistant or Nurse Practitioner experience preferred. Health is currently seeking to hire a full-time, Nurse Supervisor/ Charge...
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Associate Care Management Coordinator

Highmark Health 6 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...

Mental Health RN (Home Health) Part-time

Celtic Healthcare - Pittsburgh, PA
Review the home health referral, updating & communicating any changes to other disciplines and to customer service center....

Clinical Auditor/Analyst

UPMC 272 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- UM Nurse Consultant

Aetna 461 reviews - Pittsburgh, PA
Utilization management preferred. You will conduct Utilization Review and Discharge Planning for members admitted to an acute facility....

Case Manager II

HealthSouth Corporation - Pittsburgh, PA
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....

Case Manager, Home Health

UPMC 272 reviews - Pittsburgh, PA
Establish a physician-directed, individualized treatment plan in conjunction with Utilization Management staff....
Registered Nurse Telephonic Triage
Maxim Healthcare Services 762 reviews - Pittsburgh, PA
Maxim Healthcare seeking energetic RN’s for new Telephonic, Utilization Review positions with competitive pay. Current Registered Nurse License for the state in...
Sponsored by Maxim Healthcare Services - 30+ days ago
Telephonic Care Advocate. Work from Home.
UnitedHealth Group 1,926 reviews - Pittsburgh, PA
· Managed care or utilization review experience. · Conduct focused utilization reviews effectively and efficiently; Or registered psychiatric nurse....
Sponsored by UnitedHealth Group - 26 days ago
RN Case Manager
Community LIFE 13 reviews - Pittsburgh, PA
Working knowledge of utilization review, quality assurance and managed health care concepts. Community LIFE is recruiting an experienced RN who is interested in...
Sponsored by Community LIFE - 1 day ago

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1,926 reviews
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