Utilization Review Nurse jobs in Pittsburgh, PA

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Case Manager / Utilization Review RN
Maxim Healthcare Services - 1,090 reviews - Pittsburgh, PA
$24 - $27 an hour
New Registered Nurse Case Manager / Utilization Review openings in Pittsburgh, PA. Participate in Quality Assurance and Utilization review activities, as...
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Manager, Utilization Management
FamilyCare Health - 6 reviews - United States
Provide department direction and leadership through the Supervisor, Utilization Review. Concurrent review experience....
Clinic RN
Community LIFE - 15 reviews - Pittsburgh, PA
Working knowledge of utilization review, quality assurance and managed health care concepts. Licensed Registered Nurse in Pennsylvania....

RN Utilization Review

Medix - 49 reviews - Pittsburgh, PA
Utilization Review Nurse is responsible for conducting admission and concurrent utilization review for members....

Authorization Nurse

UPMC - 368 reviews - Pittsburgh, PA 15203 (Southside Slopes area)
Prior utilization review experience. Are you an experienced nurse? Maintain collaborative relationships with utilization management and departments at payor...

Case Manager

Aetna - 1,547 reviews - Township of Moon, PA
Nursing/Registered Nurse is desired. Click here to review the benefits associated with this position....

Utilization Management (UM) Care Manager - Ancillary

UPMC - 368 reviews - Pittsburgh, PA 15219 (Middle Hill area)
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...


Metro Community Health Center - Pittsburgh, PA
Participates in peer review by performing chart review and working with the quality improvement committee to develop clinical assessment tools, etc....

Clinical Appeals Coordinator (RN)

UPMC - 368 reviews - Pittsburgh, PA 15219 (Middle Hill area)
Two years of Health Insurance experience as a Registered Nurse in a Utilization Management/Medical Management role strongly preferred....

Care Coordinator

naviHealth - Pittsburgh, PA 15219 (Middle Hill area)
Complete Utilization Management functions for authorizations. The health care team includes physicians, health plan UM/CM Nurse, hospital discharge planners,...

Clinical Auditor/Analyst - Fraud and Abuse

UPMC - 368 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;...

Call Center Agent - Associate Care Management Coord - Pre-Ce...

Highmark Health - 25 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...

Care Manager RN

Highmark Health - 25 reviews - Pittsburgh, PA
RN (Registered Nurse) license. Certification in utilization management or a related field. Responsible for the implementation of effective utilization...
Director of Nursing
Western Pennsylvania Home Health Association - Pittsburgh, PA
$75,000 a year
Evaluates own job performance and utilization of resources in planning for professional growth. Reviews and audits patient charts as it pertains to direct...
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Utilization Review Nurse (Traveler)
Alaska Native Tribal Health Consortium - 23 reviews - Pittsburgh, PA
$5.50 an hour
Performs utilization review in accordance with all state mandated regulations. Obtains and reviews necessary medical reports and subsequent treatment plan...
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