Utilization Review Nurse Jobs | Glassdoor
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Utilization Review Nurse Jobs

  • 3.6
    Commonwealth Care Alliance – Boston, MA
    11 days ago 11d
    organizational determinations. The Utilization Management ReviewNurse reports to the Utilization Management Nurse Manager. Key Responsibilities… The Utilization Management (UM) ReviewNurse is responsible for day-to-day timely clinical and service authorization review for…
  • 3.2
    MemorialCare Health System – Fountain Valley, CA
    26 days ago 26d
    California Registered Nurse (RN) preferred. Licensed Vocational Nurse (LVN) with consideration made based on utilization management and… complex clinical, benefit and network decisions. Apply UtilizationReview Management process to ensure continuity of care throughout…
  • 3.1
    Blue Cross and Blue Shield of Texas – Richardson, TX
    Est. Salary $78k-$99k
    8 days ago 8d
    members, providers and facilities. JOB REQUIREMENTS: *Registered Nurse (RN) with valid, current, unrestricted license in the state… identifies and reports cases, and provides information regarding utilization management requirements and operational procedures to members…
  • 4.5
    ViziRecruiter – Detroit, MI
    20 days ago 20d
    a Healthcare Company and they are searching for a UtilizationReviewNurse To learn more, please click on the 'apply on company… company website' button above. Keywords: Healthcare, Medical, Nursing, Patient Care…
  • 3.8
    Adventist Health System – Tampa, FL
    Est. Salary $51k-$64k
    30+ days ago 30d+
    RNs and under the general direction of the Director of UtilizationReview, with oversight of authorization support staff workflows… Minimum five (5) years acute clinical nursing experience Active Florida Registered Nursing license Commercial or managed care…
  • 3.5
    Washington Hospital Center – Washington, DC
    NEW
    Appeals assists in the administration of utilization functions, the UtilizationReviewNurse, assesses patient insurance/status to… to facilitate appropriate completion of utilizationreview using payer specific criteria; uses Interqual and MCG to determine medical…
  • 3.3
    Carilion Clinic – Atlanta, GA
    Est. Salary $46k-$59k
    10 days ago 10d
    practice model · Extensive nursing research funding and continued education support · A year-long nurse residency program for new… Registered Nurse in Virginia or eligible to obtain Virginia RN licensure. · Graduate of school of professional nursing of an accredited…
  • 3.6
    Oscar Insurance – Los Angeles, CA
    10 days ago 10d
    UtilizationReviewNurse At Oscar, we work hard to provide the kind of health insurance we would want for ourselves. This means… appropriate care in a timely, transparent way. As a UtilizationReviewNurse, you will determine the medical appropriateness of…
  • 3.3
    WellCare – Tampa, FL
    17 days ago 17d
    skilled nursing facility reviews Preferred- Strong preference for previous experience in utilizationreview/utilization management… Education: Required A High School or GED Utilizationreviewnurseutilization management managed care health integrated Humana…
  • KORAK – Washington, DC
    NEW
    inappropriate utilization of resources to the Chief Medical Officer; identifies and reports quality and or utilization issues to the… the Chief Medical Officer. Reviews health plan, appeal items for concurrent and retrospective reviews as required and requested…
  • 4.4
    Central California Alliance for Health – Merced, CA
    Est. Salary $67k-$135k
    7 days ago 7d
    which include UM Concurrent Review and SNF Programs; Performs duties as a UM Concurrent ReviewNurse, as needed; Assists UM Manager… Concurrent ReviewNurse, as needed, with duties including but not limited to: Providing UM Concurrent Review coverage in…
  • 3.5
    Rising Medical Solutions – Chicago, IL
    EASY APPLY
    5 days ago 5d
    Solutions has an opening for an UtilizationReviewNurse, and we want to hear from you! We're a bill review and cost containment company… cost of healthcare claims through bill review, case management, and utilizationreview. Our mission is "To protect the health…
  • 3.5
    Carolinas HealthCare System – Concord, NC
    4 days ago 4d
    admission and concurrent reviews. Applies clinical guidelines during Admission and Concurrent reviews and identifies potential… and Certifications Graduation from an accredited School of Nursing. NC RN licensure required. Related experience preferred. Basic…
  • 3.3
    WellCare – Phoenix, AZ
    21 days ago 21d
    LPN licensed Experience: Minimum of 1 year of general nursing experience. Managed care experience preferred. Licenses… completion of ER PLP reconsiderations from receipt to adjudication. Utilizes clinical knowledge to evaluate and assess the clinical necessity…
  • 4.5
    ViziRecruiter – Detroit, MI
    19 days ago 19d
    client, Trusted Health Plan is looking to fill an open UtilizationReviewNurse position. To learn more about this position, please…
  • 4.1
    Integrated Resources – Edison, NJ
    Est. Salary $58k-$91k
    11 days ago 11d
    Reviewing medical information and making a recommendation to the medical director regarding admission to an inpatient hospital…
  • 3.5
    Quantum Health – Columbus, OH
    25 days ago 25d
    Job Title: Utilization Management Nurse (LPN) Working Group: Clinical Operations Reports to: Pod Manager Quantum Health… join our winning culture! We are looking for an LPN Utilization Management Nurse. Roles and Tasks: Promote the mission…
  • 3.7
    Alvarez & Marsal – New York, NY
    NEW
    care. Senior Associate-UtilizationReviewNurse Consultant: The Senior UtilizationReviewNurse Consultant is responsible… Associate- utilizationreviewnurses responsibilities include, but are not limited to: Care Facilitation, Utilization Management…
  • 3.5
    Santa Barbara Cottage Hospital – Santa Barbara, CA
    26 days ago 26d
    - CA Registered Nurse The UtilizationReviewNurse is responsible for utilizationreview, utilization management, and quality… relevant stakeholders with regard to utilizationreview management. The UtilizationReviewNurse will work collaboratively and…
  • 3.5
    Presbyterian Healthcare Services – Albuquerque, NM
    Est. Salary $58k-$74k
    18 days ago 18d
    Credentials: Registered Nurse - State of New Mexico or Compact State Nursing License or Graduate Nurse Permit required. BLS certification… Associate Degree in Nursing (BSN completion within 5 years of hire) Degree from accredited academic nursing program (If a program…
  • 3.8
    Cleveland Clinic – Independence, OH
    26 days ago 26d
    Education: Associate's degree in Nursing (Licensed Practical Nurse, Registered Nurse) or Health Information Technology.… Current state licensure as a Licensed Practical Nurse (LPN) or Registered Nurse (RN). Complexity of Work: Requires critical…
  • 3.9
    Advanced Resources (IL) – Maywood, IL
    12 days ago 12d
    looking for a UtilizationReview Registered Nurse with Interqual, EPIC and AllScripts experience. The UtilizationReview RN will be… AllScripts Experience with UtilizationReview in an inpatient setting 2-5 years of UtilizationReview experience RN Required…
  • 3.5
    Quantum Health – Columbus, OH
    Est. Salary $61k-$77k
    25 days ago 25d
    Job Title: Utilization Management Nurse (RN) Working Group: Clinical Services Reports to: POD Manager Quantum… to join our winning culture! We are looking for a Utilization Management Nurse. Roles and Tasks: Promote the mission…
  • 4.6
    Cencal Health – Santa Barbara, CA
    Est. Salary $52k-$70k
    11 days ago 11d
    work environment) The UM Nurse performs prospective, concurrent, and retrospective reviews for long- term care, acute inpatient… acute care, subacute, skilled nursing, and long-term care setting Perform timely retrospective review for services that required…
  • 3.7
    Harvard Pilgrim Health Care – Quincy, MA
    4 days ago 4d
    Associate UtilizationReviewNurse is responsible for the administration of Harvard Pilgrim’s pre-admission review process for… physician review and complete determinations following physician review. This individual will perform duties to support review of requested…
  • 4.1
    Integrated Resources, Inc. – Denver, CO
    5 days ago 5d
    Title: UtilizationReviewNurse Location : Denver CO 80204 Duration : 3+ Months Contract with extension Details: Under… additional review by the Plans Medical Director. MINIMUM QUALIFICATIONS: Education: Bachelors degree in Nursing. A combination…
  • 3.2
    The Judge Group, Inc. – Marlton, NJ
    5 days ago 5d
    539447 Judge Healthcare is currently seeking a UtilizationReviewNurse for our best client in Marlton, NJ This job will… an experienced RNs to work on a pilot for centralized UtilizationReview Must have UR experience Recent hospital /acute care…
  • 3.4
    Medix – Boston, MA
    11 days ago 11d
    identified variances or specific members according to criteria utilized for appropriate level of care. Identifies opportunities for… so please feel free to apply! Job Responsibilities: Reviews inpatient admissions, continued stays, specialty referrals…
  • 4.4
    Central California Alliance for Health – Scotts Valley, CA
    Est. Salary $82k-$101k
    4 days ago 4d
    skilled-nursing and long-term care facilities to perform concurrent and/or retrospective review; Knowledge of Utilization Management… confidentiality of utilizationreview, quality management information and beneficiary identification; and Attending Concurrent Review Rounds…
  • 3.0
    UniMed Direct – Richardson, TX
    NEW
    rush hour? We are looking for a RN with at least 2 years of nursing experience and knowledge of commercial evidence based guidelines…
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