Utilization Review RN jobs in Pittsburgh, PA

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Nurse Clinician RN (Cross Functional)
Express Scripts 690 reviews - Warrendale, PA
The Nurse Clinician RN is responsible for reviewing... reviews for providers, members and patient client advocates within the Prior Authorization/Utilization...
Sponsored by Express Scripts - 11 days ago
RN Case Manager Hospice
Bethany Hospice - Pittsburgh, PA
years in a row! RN needed for full time hospice case manager field position. Requires at least one year of relevant experience, a current PA RN license, and...
Easily apply
Sponsored by Bethany Hospice - 13 days ago

RN-Review and Evaluation of Medical Care and Services-TRAVEL

InGenesis 7 reviews - Pittsburgh, PA 15222 (Strip District area)
RN-Review and Evaluation of Medical Care and Services-Non Direct Care- TRAVEL. HIRING IMMEDIATELY to provide services for the Commonwealth of Pennsylvania Great...
3 days ago - save job - block - email - more...

Utilization Reviewer, Casual - FH

Jefferson Hospital 15 reviews - Monroeville, PA
Maintains a working knowledge of care management, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as...
3 days ago - save job - block - email - more...

Consultant-Absence Management

Alliant Insurance Services 7 reviews - Pittsburgh, PA
adjusts absence management strategies, particularly in the areas of non-occupational disability, FMLA and statutory leave management programs, return to work...
20 days ago - save job - block - email - more...

Retrospective Appeals Nurse

UPMC 207 reviews - Pittsburgh, PA
- Perform clinical review for cases referred for retrospective appeal to determine if appeal is warranted. - Identify and assign a root cause to each case to...
18 days ago - save job - block - email - more...

Nurse Clinician RN (Cross Functional)

Express Scripts 690 reviews - Warrendale, PA
The Nurse Clinician RN is responsible for reviewing escalated clinical criteria reviews for providers, members and patient client advocates within the Prior...
11 days ago - save job - block - email - more...

Utilization Reviewer - FH

Forbes Hospital - Monroeville, PA
Maintains a working knowledge of care management, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as...
30+ days ago - save job - block - email - more...

(RN) Mercer Health Advantage Nurse Case Manager (Pittsburgh,...

Cigna 680 reviews - Pittsburgh, PA
Involves close interaction and collaboration with internal and external health care partners and includes customer- and consultant-facing activities....
2 days ago - save job - block - email - more...

Manager Utilization Management

Highmark Health - Pittsburgh, PA
Manage utilization management daily operations to ensure medically necessary services are provided in a timely, cost effective and quality manner, and at the...
Highmark Inc. - 30+ days ago - save job - block - email - more...

Manager, Medical Review

Novitas RPO - Pittsburgh, PA 15219 (Middle Hill area)
Incumbent is responsible for oversight to all departmental procedures, policies, management controls, ISO 9001:2000 compliance for complex activities relating... $194,000 a year
30+ days ago - save job - block - email - more...

Utilization Reviewer - AHN

Allegheny Health Network – Corporate - Pittsburgh, PA
Maintains a working knowledge of care management, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as...
30+ days ago - save job - block - email - more...
Healthcare Provider - (RN) Hospital Case Management - Manage...
Deloitte 1,161 reviews - Pittsburgh, PA
or methodologies to review, design and/or implement... physical therapist, physician etc.) -Must be an RN. -Hospital Case Management experience is a MUST...
Sponsored by 6FigureJobs - 8 days ago
Med Documentation Spec - Pool
Mercy Health 41 reviews - United States
the medical staff, utilization review/case management... Completes initial review, follow up reviews, mortality reviews, and secondary reviews of patient records...
Sponsored by TweetMyJobs.com - 19 days ago
Renal Program Clinical Director
Pentec Health 4 reviews - United States
liaison for RN credentialing; sales education presentations; sales training materials; patient education materials and other collateral materials. Review all...
Sponsored by Pentec Health - 30+ days ago

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Company with Utilization Review RN jobs
690 reviews
Express Scripts is a Fortune 25 company and is the largest pharmacy benefit manager in the U.S.
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