RN Utilization Review jobs in Pittsburgh, PA

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RN Case Manager
Community LIFE - 20 reviews - Pittsburgh, PA
Working knowledge of utilization review, quality assurance and managed health care concepts. Please select location you are interested in:....
Outpatient RN Supervisor
TCV Community Service - Homestead, PA
Responsible for utilization review and supports MD/CRNP productivity. Current PA license as RN with 3 years nursing experience in behavioral health setting....
RN, Case Manager, Case Mgmt, PRN, Days, RSWH
Current utilization review experience handling commercial insurance cases using Navinet software required....

Care Manager Medicare Appeals

Highmark Inc - 60 reviews - Pittsburgh, PA 15222 (Strip District area)
RN (Registered Nurse) license. This job implements effective utilization management strategies including:. Review of appropriateness of health care services,...

Quality Nurse Coordinator

UPMC - 486 reviews - Pittsburgh, PA 15213 (North Oakland area)
Oversees the ongoing medical record reviews, including reviews of documentation required for UNOS, CMS, PA DOH....

ERAS Programmatic Nurse Specialist

UPMC - 486 reviews - Pittsburgh, PA 15213 (North Oakland area)
Analyzes and disseminates current medical and nursing literature for utilization in the expansion and improvement of patient care outcomes....

Clinical Auditor/Analyst (RN) - Quality Assurance & Operatio...

UPMC - 486 reviews - Pittsburgh, PA 15219 (Middle Hill area)
Responsibilities may involve multiple line of business focused reviews, or ad hoc reviews as needed; On an as-needed basis, other responsibilities may include...

Utilzation Reviewer - Resource Center

Allegheny Health Network (Corporate) - 13 reviews - Pittsburgh, PA
Maintains a working knowledge of care management, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as...

CDI Specialist - Nurse

PA - LifeCare Hospitals of Pittsburgh - Main Campu... - Pittsburgh, PA 15221 (Oakland area)
RN with bachelor’s degree in a related field. This position provides integration of the patient’s condition with the medical record documentation, facilitates...

Clinical Documentation Specialist

Ovation, LLC - Pittsburgh, PA
Knowledge of computer technology, quality assurance activities, DRG, Utilization review highly preferred. May perform retrospective reviews to determine trends...

Telephone RN Case Manager

Keystone Peer Review - Washington, PA
Telephone RN Case Manager. QUALIFICATIONS Active, unrestricted RN licensure and graduation from School of Nursing required;...

Care Coordinator

West Penn Hospital - 38 reviews - Pittsburgh, PA
Care facilitation and utilization review experience preferred. Maintains a working knowledge of care management, care coordination changes, utilization review...

Care Coordinator

Forbes Hospital - 13 reviews - Monroeville, PA
Care facilitation and utilization review experience preferred. Maintains a working knowledge of care management, care coordination changes, utilization review...
Registered Nurse - RN - Utilization Management
Participate in Quality Assurance and Utilization review activities, as directed. Must have Utilization Management (UM) experience with Interqual....
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Quality /Utilization Management Reviewer - Mars/Warrendale,...
Home Health Quality/UM Reviewers perform home health utilization review activities as assigned:. Review charts for appropriate content, accuracy, completion of...

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