Utilization Review RN jobs in Pittsburgh, PA

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Clinical Review Nurse
Novitas Solutions, Inc. - Pittsburgh, PA 15206
Retrospective utilization review. RN. Surfacing potential fraud and abuse or practice concerns o May develop recommendations for further corrective action based...
Registered Nurse - RN - Utilization Management
Maxim Healthcare Services - 1,914 reviews - Pittsburgh, PA
$26 - $30 an hour
They will be responsible for receiving clinical information, processing and documenting it, applying Interqual or a Medical Policy, and approving or routing to...
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Risk Manager (RN)
Facility Support Company, LLC - Munhall, PA
Must have 3-5 yrs experience in Risk Management/ Utilization Review. We are looking for a Risk Manager, RN to join our growing team!*....
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UM Nurse Consultant

Aetna - 2,223 reviews - Township of Moon, PA
Click here to review the benefits associated with this position. The Utilization Management Nurse Consultant is an integral member of the care management team....

Quality Nurse Coordinator

UPMC - 469 reviews - Pittsburgh, PA 15213 (North Oakland area)
Oversees the ongoing medical record reviews, including reviews of documentation required for UNOS, CMS, PA DOH....

Telephone RN Case Manager

Keystone Peer Review - Washington, PA
Telephone RN Case Manager. QUALIFICATIONS Active, unrestricted RN licensure and graduation from School of Nursing required;...

CDI Specialist - Nurse

LifeCare Health Partners - Pittsburgh, PA 15221 (Oakland area)
RN with bachelor’s degree in a related field. This position provides integration of the patient’s condition with the medical record documentation, facilitates...

RN CDIS - onsite

Ovation RCS - Pittsburgh, PA
RN*. Knowledge of computer technology, quality assurance activities, DRG, Utilization review highly preferred....
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UM RN Reviewer

UPMC - 469 reviews - Seven Fields, PA 16046
2 years utilization review experience preferred. Review OASIS and 485 Plan of Care for accuracy and completeness and ensure correct coding assignment....

Clinical Care Manager (RN) - Washington and Fayette Counties

UPMC - 469 reviews - Pittsburgh, PA 15219 (Middle Hill area)
Review member's current medication profile; Present or contribute to complex case reviews by the interdisciplinary team summarizing clinical and social history,...

Care Coordinator

Forbes Hospital - 13 reviews - Monroeville, PA
Care facilitation and utilization review experience preferred. Maintains a working knowledge of care management, care coordination changes, utilization review...

Nurse Clincian RN Per Diem - Accredo

Express Scripts - 2,163 reviews - Warrendale, PA 15096
Previous clinical criteria review experience preferred. The Nurse Clinician – RN is responsible for reviewing escalated clinical criteria reviews for providers,...

Skilled Inpatient Care Coordinator (SICC)

naviHealth - 26 reviews - Pittsburgh, PA 15219 (Middle Hill area)
When naviHealth is delegated for utilization management review refer requests that cannot be approved for continued stay and are forwarded to licensed...
CDI Specialist - Nurse
LifeCare Health Partners - Pittsburgh, PA 15221
RN with bachelor’s degree in a related field. This position provides integration of the patient’s condition with the medical record documentation, facilitates...
Registered Nurse (RN) Clinical Nurse Consultant
The position will support these Users through regular case reviews and direct communication. The Vatica Health Clinical Consultant is responsible for driving...
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