RN Utilization Review jobs in Pittsburgh, PA

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Nurse Clinician RN (Cross Functional)
Express Scripts 920 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 - 14 days ago
Preservice Review RN - Pittsburgh, PA
UnitedHealth Group 1,874 reviews - Pittsburgh, PA
Perform utilization and concurrent review using Milliman criteria. RN, registered nurse, Pittsburgh, PA, Prior authorizations, utilization management, united...
Sponsored by UnitedHealth Group - 6 days ago
RN Case Manager Hospice
Bethany Hospice - Pittsburgh, PA
RN licensed in the state. RN needed for full time hospice case manager field position. Demonstrates expertise in utilization of team members including...
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Sponsored by Bethany Hospice - 30+ days ago

Preservice Review RN - Pittsburgh, PA

UnitedHealth Group 1,874 reviews - Pittsburgh, PA
Perform utilization and concurrent review using Milliman criteria. RN, registered nurse, Pittsburgh, PA, Prior authorizations, utilization management, united...

Registered Nurse -RN- UM Nurse Consultant

Aetna 448 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....

Associate Care Management Coordinator

Highmark Health 5 reviews - Pittsburgh, PA
Communicate effectively with Utilization Management Staff, providers, other internal and external customers and management....

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

Aetna 448 reviews - Pittsburgh, PA
Conduct Utilization Review and Discharge Planning for members admitted to an acute facility. Click here to review the benefits associated with this position....

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....

Registered Nurse Telephonic Triage

Maxim Healthcare Services 719 reviews - Sewickley, PA - +1 location
Maxim Healthcare seeking energetic RN’s for new Telephonic, Utilization Review positions with competitive pay. Must have experience with Acute Care Patients and...

Care Manager - Utilization Management RN

Highmark Health 5 reviews - Pittsburgh, PA
Current, valid, unrestricted RN license. 1 year of Utilization Management experience. Certification in Utilization Management or a related field....

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....

Nurse Clinician RN (Cross Functional)

Express Scripts 920 reviews - Warrendale, PA
Previous clinical criteria review experience preferred; The Nurse Clinician – RN is responsible for reviewing escalated clinical criteria reviews for providers,...

Clinical Appeals Coordinator

UPMC 262 reviews - Pittsburgh, PA
Create correspondence for review prior to finalizing ¿ outreach to members and/or providers as needed to obtain and review additional clinical documentation....
RN Case Manager
Community LIFE 12 reviews - McKeesport, PA
Working knowledge of utilization review, quality assurance and managed health care concepts. The RN Case Manager provides the technical, organizational and...
Sponsored by Community LIFE - 30+ days ago
Nurse (Non-Prescriber) Nursing
The Clinical Recruiter ACHCR - Pennsylvania
This position reports directly to Chief Financial Officer (CFO) and supervises Social Services, Discharge Planning Associates, and Utilization Review staff...
Sponsored by MDLinx - 2 days ago

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