Utilization Review Nurse jobs in Pittsburgh, PA

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Registered Nurse - RN - Utilization Review
Active Registered Nurse (RN) licensure in the state in which the Registered Nurse (RN) practices. This job implements effective utilization management...
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Telephonic Care Manager - CHC
UPMC - 1,696 reviews - Pittsburgh, PA 15219
Present complex members for review by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management...
Registered Nurse - Home Health- Robinson Area
Review the home health referral, updating & communicating any changes to other disciplines and to customer service center....

Post-Acute Utilization Review Nurse - Louisville, KY Preferr...

Humana - 3,233 reviews - Pittsburgh, PA
Humana is seeking a Post-Acute Utilization Review Nurse who will collaborate with other health care givers in reviewing actual and proposed medical care and...

Revenue Cycle Clinical Review Nurse

UPMC - 1,696 reviews - Pittsburgh, PA 15203 (Southside Slopes area)
Serve as a clinical liaison between revenue cycle staff, utilization review, payors and physicians when indicated....

(RN) Inpatient Nurse Case Manager (Nurse Case Manager Specia...

Cigna - 2,603 reviews - Pittsburgh, PA 15219 (Middle Hill area)
RN-Inpatient Nurse Case Manager-. Utilization management experience strongly preferred. Performs prospective, concurrent, and retrospective reviews for...

Programmatic Nurse Specialist - Diabetes

UPMC - 1,696 reviews - Pittsburgh, PA 15213 (North Oakland area)
Current Pennsylvania licensure as a Registered Professional Nurse license. The Programmatic Nurse Specialist, a professional registered nurse, has the authority...

Quality Nurse Coordinator

UPMC - 1,696 reviews - Pittsburgh, PA 15213 (North Oakland area)
Oversees the ongoing medical record reviews, including reviews of documentation required for UNOS, CMS, PA DOH. Participates with the peer review process....

Clinical Review Nurse

TDY Medical Staffing - Pittsburgh, PA
$25 - $28 an hour
Our client is currently hiring a Medical Review Nurses for a 6 month contract position located in Pittsburgh, PA....
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Registered Nurse Assessment Coordinator (RNAC)

Guardian Staffing Agency - Pittsburgh, PA
$40 - $45 an hour
Registered Nurse (RN). Facilitates the Medicare Utilization meeting at least weekly & reviews the Managed Care cost analysis....
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Utilzation Reviewer - Resource Center

Allegheny Health Network (Corporate) - 16 reviews - Pittsburgh, PA
Maintains a working knowledge of care management, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as...

Clinical Consultant RN

Vatica Health - Pittsburgh, PA
The position will support these Users through regular case reviews and direct communication. A certified Registered Nurse (RN) or other licensed clinician (such...

Clinical Auditor/Analyst (RN)- Fraud, Waste & Abuse

UPMC - 1,696 reviews - Pittsburgh, PA 15219 (Middle Hill area)
Registered Nurse (RN). Responsibilities may involve multiple line of business focused reviews, or ad hoc reviews as needed;...
Clinical Consultant RN
Vatica Health - Pittsburgh, PA
The position will support these Users through regular case reviews and direct communication. A certified Registered Nurse (RN) or other licensed clinician (such...
Lead Clinical Review Nurse
Novitas Solutions, Inc. - Pittsburgh, PA 15206
The Lead Clinical Review Nurse serves as the subject matter expert (SME) to peers, external and internal customers in relation to review decisions and inquiries...