Utilization Review Nurse jobs in Pittsburgh, PA

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RN Case Manager
Community LIFE 12 reviews - McKeesport, PA
Working knowledge of utilization review, quality assurance and managed health care concepts. Licensed Registered Nurse in Pennsylvania....
Sponsored by Community LIFE - 30+ days ago
RN Hospice Case Manager-1 Year RN Exp
Bethany Hospice - Pittsburgh, PA
REGISTERED NURSE CASE MANAGER. Demonstrates expertise in utilization of team members including volunteers and community resources....
Easily apply
Sponsored by Bethany Hospice - 30+ days ago
Registered Nurse Telephonic Triage - Utilization Review
Maxim Healthcare 723 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 NurseJobsNationwide.com - 27 days ago

Telephonic Care Manager - UPMC Health Plan Maternity

UPMC 263 reviews - Pittsburgh, PA
Review member¿s current medication profile; Refers member for Comprehensive Medication Review as appropriate....

Registered Nurse -RN- UM Nurse Consultant

Aetna 453 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....

Clinical Appeals Coordinator

UPMC 263 reviews - Pittsburgh, PA
Two years of Health Insurance experience as a Registered Nurse in a Utilization Management/Medical Management role strongly preferred....

Preservice Review RN - Pittsburgh, PA

UnitedHealth Group 1,887 reviews - Pittsburgh, PA
Perform utilization and concurrent review using Milliman criteria. As a Preservice Review Nurse your duties will include:....

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

Aetna 453 reviews - Pittsburgh, PA 15220
Conduct Utilization Review and Discharge Planning for members admitted to an acute facility. Nursing/Registered Nurse (RN) is required....

UM Care Manager - UPMC Health Plan

UPMC 263 reviews - Pittsburgh, PA
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care, as well...

Associate Care Management Coordinator

Highmark Health 5 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...

Clinical Auditor/Analyst

UPMC 263 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...

Case Manager, Home Health (Full-Time) Huntingdon, PA

UPMC 263 reviews - Pittsburgh, PA
Establish a physician-directed, individualized treatment plan in conjunction with Utilization Management staff....

Telephonic Care Advocate. Work from Home.

UnitedHealth Group 1,887 reviews - Pittsburgh, PA
· Managed care or utilization review experience. · Conduct focused utilization reviews effectively and efficiently; Or registered psychiatric nurse....
Preservice Review RN
United Health Group 1,887 reviews - Pittsburgh, PA
Perform utilization and concurrent review using Milliman criteria. As a Preservice Review Nurse your duties will include:....
Sponsored by NurseJobsNationwide.com - 10 days ago
Registered Nurse Telephonic Triage
Maxim Healthcare 723 reviews - Sewickley, PA
Maxim Healthcare seeking energetic RN's for new Telephonic, Utilization Review positions with competitive pay....
Sponsored by NurseJobsNationwide.com - 10 days ago

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