Utilization Review RN jobs in Pittsburgh, PA

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Registered Nurse Telephonic Triage - Utilization Review
Maxim Healthcare Services 762 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
Registered Nurse - RN - Telephonic
Maxim Healthcare Services 762 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
Maxim Healthcare Services 762 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

Triage Nurse

CorVel 23 reviews - Pittsburgh, PA
Strong cost containment background, such as utilization review or managed care also useful. Current RN licensure in state of operation....

Clinical Appeals Coordinator

UPMC 272 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....

Utilization Reviewer (Part-Time)- FH

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

Case Manager, Home Health

UPMC 272 reviews - Pittsburgh, PA
Minimum 1 year satisfactory performance as RN II preferred. Establish a physician-directed, individualized treatment plan in conjunction with Utilization...

Nurse Clinician RN (Cross Functional)

Accredo Health Group, Inc - Warrendale, PA
Previous clinical criteria review experience preferred; The Nurse Clinician – RN is responsible for reviewing escalated clinical criteria reviews for providers,...

Registered Nurse- RN- UM Nurse Consultant

Aetna 461 reviews - Pittsburgh, PA
Utilization management preferred. You will conduct Utilization Review and Discharge Planning for members admitted to an acute facility....

Care Manager - Utilization Management RN

Highmark Health 6 reviews - Pittsburgh, PA
Current, valid, unrestricted RN license. 1 year of Utilization Management experience. Certification in Utilization Management or a related field....

Case Manager II

HealthSouth Corporation - Pittsburgh, PA
The CM II performs ongoing utilization review and acts as a liaison to the payor while assuring that cost effective treatment is provided by the team....

Mental Health RN (Home Health) Part-time

Celtic Healthcare - Pittsburgh, PA
Licensed RN or BSN with current state license. In addition, the Mental Health RN will carry out all duties of a RN including coordinate the home care of...

Case Manager II - Pool

HealthSouth Corporation - Sewickley, PA - +1 location
The CM II performs ongoing utilization review and acts as a liaison to the payor while assuring that cost effective treatment is provided by the team....
Registered Nurse - RN - Clinical Quality Manager
Maxim Healthcare Services 762 reviews - Pittsburgh, PA
NCQA experience is required, and knowledge of utilization review and case management is preferred. Successful completion of screening tests for the clinical...
Sponsored by Maxim Healthcare Services - 30+ days ago
RN Hospice Case Manager-1 Year RN Exp
Bethany Hospice - Pittsburgh, PA
RN licensed in the state. RN needed for full time hospice case manager field position. Demonstrates expertise in utilization of team members including...
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Sponsored by Bethany Hospice - 30+ days ago

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