RN Utilization Review jobs in Pittsburgh, PA

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Registered Nurse - RN - Telephonic
Maxim Healthcare Services 772 reviews - Pittsburgh, PA
Participate in Quality Assurance and Utilization review activities, as directed. Current RN License. Maintain accurate and timely patient information, which...
Sponsored by Maxim Healthcare Services - 30+ days ago
Registered Nurse Telephonic Triage - Utilization Review
Maxim Healthcare Services 772 reviews - Pittsburgh, PA
2-4 years of recent working RN utilization review or case management experience is required. We have immediate openings for Utilization Management RN’s in the...
Sponsored by Maxim Healthcare Services - 30+ days ago

Registerd Nurse - RN Utilization Management Nurse Consultant

Aetna 467 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....

Care Manager

Value Options 139 reviews - Trafford, PA
Applies utilization management policies and procedures for determination of initial, concurrent and retrospective review....

Registered Nurse (RN) Utilization Management Nurse Consultan...

Aetna 467 reviews - Pittsburgh, PA
This role will conduct Utilization Review and Discharge Planning for members admitted to an acute facility. Click here to review the benefits associated with...

Coordinator, Med Management RN - UPMC Health Plan

UPMC 274 reviews - Pittsburgh, PA
Coordinate evidence documentation for external reviews for Clinical Resource Management, i.e. NCQA surveys, DPW and Medicare reviews....

Authorization Nurse - UPMC Corporate Services

UPMC 274 reviews - Pittsburgh, PA
Qual criteria appropriately Prior utilization review experience Knowledge of payor reimbursement structure....

Triage Nurse

CorVel 23 reviews - Pittsburgh, PA
Strong cost containment background, such as utilization review or managed care also useful. Review Claim Files and provide assessment....

Nurse Supervisor - Cranberry Twnship, PA

RestorixHealth 7 reviews - Township of Cranberry, PA
Regularly reviews the Charge Description Master and Superbill to ensure appropriate reimbursement. Reviews retrospectively monthly outcome report(s) and...
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Utilization Reviewer- FH

Forbes Hospital - Monroeville, PA
Maintains a working knowledge of care management, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as...

Lead Care Manager - UPMC St. Margaret

UPMC 274 reviews - Pittsburgh, PA
Audits and evaluates the daily activates of Care management staff including utilization review, discharge planning, documentation, and interdisciplinary rounds....

Clinical Appeals Coordinator

UPMC 274 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....
Triage Nurse
CorVel 23 reviews - Pittsburgh, PA
Strong cost containment background, such as utilization review or managed care also useful. Review Claim Files and provide assessment....
Sponsored by CorVel - 8 days ago
Registerd Nurse - RN Utilization Management Nurse Consultant
Aetna 467 reviews - Pittsburgh, PA
Conduct Utilization Review and Discharge Planning for members admitted to an acute facility. Clickhereto review the benefits associated with this position....
Sponsored by Job.com - 17 hours ago
Registered Nurse Telephonic Triage
Maxim Healthcare Services 772 reviews - Pittsburgh, PA
Maxim Healthcare seeking energetic RN’s for new Telephonic, Utilization Review positions with competitive pay. Must have experience with Acute Care Patients and...
Sponsored by Maxim Healthcare Services - 30+ days ago

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