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Utilization Review Jobs

130,522Jobs

  • 4.3
    Newport Academy – Bethlehem, CT
    EASY APPLY
    NEW
    seeking a UtilizationReview Specialist. Under the supervision of the Director of UtilizationReview, the UtilizationReview Specialist… and families. The UtilizationReview Specialist is responsible for organizing and coordinating UtilizationReview activities within…
  • Red River Youth Academy – Norman, OK
    NEW
    Job Description The UtilizationReview Specialist is responsible for proactively monitoring the utilization of continuum services… optimize reimbursement for the system. Duties include: Review clinical documentation on each patient and works directly with…
  • 3.8
    UT Southwestern Medical Center – Dallas, TX
    $57k-$72k(Glassdoor est.)
    7 days ago 7d
    Consistently relates utilization assessment to payers that are needed to justify continued stay review and to obtain pre-certification…
  • 3.7
    Florida Hospital – Orlando, FL
    HOT
    with clinical staff, psychiatric utilization care managers and payer mix. The UtilizationReview Specialist provides comprehensive… concurrent daily reviews for admissions and continued stays according to specified criteria by the UtilizationReview and Care Management…
  • 3.8
    UT Southwestern Medical Center – Dallas, TX
    5 days ago 5d
    Consistently relates utilization assessment to payers that are needed to justify continued stay review and to obtain pre-certification…
  • 4.5
    ViziRecruiter – Detroit, MI
    HOT
    is a Healthcare Company and they are searching for a UtilizationReview Nurse To learn more about this opportunity, please click…
  • 3.8
    UT Southwestern Medical Center – Dallas, TX
    19 days ago 19d
    Consistently relates utilization assessment to payers that are needed to justify continued stay review and to obtain pre-certification…
  • 2.5
    Collateral Management LLC – Fort Lauderdale, FL
    HOT
    needed. Job Description: The documentation review will include a review of the entire file to determine whether all items… obtained in the Appraisal Report process will be reviewed. The auditor will review the file documents, including any purchase contracts…
  • 3.9
    Hendrick Health System – Austin, TX
    $52k-$66k(Glassdoor est.)
    25 days ago 25d
    JOB SUMMARY: The UtilizationReview (UR) Nurse is a registered nurse who provides clinical review against nationally recognized… health plan utilization departments regarding medical necessity for prospective, concurrent and retrospective reviews. The UR RN…
  • 3.3
    Presbyterian Healthcare Services – Albuquerque, NM
    12 days ago 12d
    expertise performing utilization management functions (i.e., prior authorization, medical claims review to include prospective… appropriate setting. Utilizes clinical skills to to coordinate, document and communicate all aspects of the utilization/benefit management…
  • 3.8
    UT Southwestern Medical Center – Dallas, TX
    NEW
    Consistently relates utilization assessment to payers that are needed to justify continued stay review and to obtain pre-certification…
  • 3.1
    HonorHealth – Scottsdale, AZ
    $64k-$80k(Glassdoor est.)
    21 days ago 21d
    appeals to payers on patient account denials when appropriate; reviews medical records and other patient documents as needed to support…
  • 3.7
    Scripps Health – La Jolla, CA
    $47k-$64k(Glassdoor est.)
    13 days ago 13d
    Director. Supports the development, utilization, implantation, and monitoring of utilizationreview/performance improvement projects… admission, concurrent, and retrospective case review for all payor sources. Reviews all admissions for appropriate level of care…
  • 3.1
    MemorialCare Health System – Fountain Valley, CA
    22 days ago 22d
    complex clinical, benefit and network decisions. Apply UtilizationReview Management process to ensure continuity of care throughout… necessity review. Follow all department P&Ps as applicable to job. Demonstrate the ability to consistently utilize the computer…
  • 3.2
    SCL Health – Billings, MT
    $74k-$96k(Glassdoor est.)
    21 days ago 21d
    Billings, MT. This RN Case Manager role is focused on UtilizationReview of patients out of Surgery or PACU. In this role you will… Identifies possible situations of abuse, neglect or exploitation utilizing knowledge of physical and psychosocial indicators of abuse…
  • 3.5
    MultiCare Health System – Tacoma, WA
    $67k-$86k(Glassdoor est.)
    13 days ago 13d
    Position Summary: The UtilizationReview (UR) Specialist is responsible for concurrent utilization management activities to… to a defined patient population. The UtilizationReview (UR) Specialist is a link between the patient, health care team, organization…
  • 3.5
    Commonwealth Care Alliance – Boston, MA
    20 days ago 20d
    The Utilization Management (UM) Review Nurse is responsible for day-to-day timely clinical and service authorization review for… organizational determinations. The Utilization Management Review Nurse reports to the Utilization Management Nurse Manager. Key…
  • 2.7
    Boys Town Hospital – Omaha, NE
    $51k-$66k(Glassdoor est.)
    7 days ago 7d
    administrative duties pertaining to utilizationreview, audit, billing and reimbursement activities, utilizing knowledge of both nursing… and accountable for the management of utilizationreview through ensuring timely review of all hospital admissions and insurance…
  • 3.6
    Johns Hopkins Hospital – Baltimore, MD
    19 days ago 19d
    groundbreaking medical research. The UtilizationReview Nurse performs utilizationreview of all patients presenting for hospitalization… of all hospitalizations, inpatient or outpatient. The UtilizationReview Nurse collaborates with physicians, the health care team…
  • 4.5
    ViziRecruiter – Detroit, MI
    27 days ago 27d
    client, Trusted Health Plan is looking to fill an open UtilizationReview Nurse position. To learn more about this opportunity,…
  • 3.4
    Riverside Health System – Newport News, VA
    $51k-$66k(Glassdoor est.)
    27 days ago 27d
    the leadership team to provide a comprehensive range of utilizationreview services associated with and in accordance with standards… experience. Related experience or basic understanding of utilizationreview.…
  • 3.1
    Howard County General Hospital – Columbia, MD
    8 days ago 8d
    The UtilizationReview (UR) Nurse is responsible to the Manager, Utilization Management. This individual performs UR and Payor… design and initiate special projects as supervised by Manager, Utilization Management. Other (Please specify below) Day Shift…
  • 3.1
    MemorialCare Health System – Long Beach, CA
    15 days ago 15d
    Outpatient UtilizationReview Assistant, using decision trees and standard work, is responsible for a broad range of utilization review… Admitting Central Auth Unit/medical group experience in utilizationreview, insurance contracts, multi-payer inpatient authorization…
  • 3.9
    Medical Solutions – Santa Rosa, CA
    6 days ago 6d
    Hospital in Northern CA near wine country is in need of UtilizationReview RN's. Knowledge of InterQual critieria is required. Please…
  • 3.3
    McLaren Health Care – Mount Clemens, MI
    NEW
    Management, the UtilizationReview Specialist is responsible for facilitating and coordinating UtilizationReview activities in… Requisition Number 17-6252 Post Date 11/22/2017 Title UtilizationReview Specialist Job Family Health Professional Subsidiary…
  • 5.0
    CMP.jobs – Kansas City, MO
    NEW
    Employer- Plaza is seeking a UtilizationReview RN. Kansas and Missouri RN license required. Bachelor's Degree, strong clinical… clinical background, and UtilizationReview experience preferred.…
  • 4.0
    Equian LLC – Golden, CO
    13 days ago 13d
    The Bill Review Nurse (RN/LPN) is responsible for reviewing and analyzing hospital bills. The clinical reviewer is responsible… comprehensive understanding of the claim review process including clinical claim review and a broad knowledge of applicable billing…
  • 3.2
    INFINITY BEHAVIORAL HEALTH SERVICES – Fort Lauderdale, FL
    EASY APPLY
    6 days ago 6d
    maintain regulatory compliance. INFINITY is now seeking UtilizationReview Specialists to join our team. INFINITY offers competitive… Medicine) criteria to review clinical information with insurance companies Performs peer to peer reviews and appeals with insurance…
  • 3.3
    Presbyterian Healthcare Services – Albuquerque, NM
    28 days ago 28d
    documentation in the medical record. Will be responsible to review physician documentation on a daily basis, keep track of patient… coverage issues and a team player in consultation with other reviewers and HIM coders. Excellent communication skills are essential…
  • 3.6
    Broadspire – Sunrise, FL
    6 days ago 6d
    caseload to meet department objectives. Utilizes appropriate resources to perform the bill review process, this includes but is not… caseload to meet department objectives. Utilizes appropriate resources to perform the bill review process, this includes but is not…
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