Utilization Review Nurse Jobs

CentralCare Inc

Registered Nurse- Utilization Management

$43 / hour
Join our team at Lackland Air Force Base and become part of a mission-driven healthcare team dedicated to providing exceptional support to active-duty service members, retirees, and their families. If you're looking for a rewarding career with excellent benefits and the opportunity to serve those who serve our nation, we'd love to hear from you! Registered Nurse –Utilization Management - Lackland AFB Location: San Antonio, TX Compensation & Benefits $43.00/hour Base Rate $5.42/hour Health &…
Molina Healthcare

RN/LVN Care Review Clinician (CA License/PST hours)

$27.61 - $53.83 / hour
JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure…
Molina Healthcare

RN/LVN Care Review Clinician CA License, PST hours

$27.61 - $53.83 / hour
JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure…
Molina Healthcare

RN/LVN Care Review Clinician/ CA License, PST hours

$27.61 - $53.83 / hour
JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure…
Molina Healthcare

RN Care Review Clinician

$30.37 - $59.21 / hour
JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure…
McLean Affiliates

OASIS Quality Review RN

$42 - $48 / hour
Overview We are seeking a dedicated and detail-oriented OASIS Quality Review Registered Nurse (RN) to join our healthcare team. The ideal candidate will play a vital role in ensuring the accuracy and completeness of OASIS assessments, supporting quality assurance initiatives, and maintaining compliance with home health and hospice regulations. This position offers an opportunity to contribute to improving patient care quality through meticulous review and analysis of clinical documentation.…
Kaiser Permanente

Case Management Utilization RN, PD Night

Job Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a safe and acceptable discharge plan. Functions as an indirect caregiver, patient advocate and manages patients in the most cost effective way…
L.A. Care Health Plan

Utilization Management Clinical Quality Nurse Reviewer RN II

$88,854 - $142,166 / year
Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health…
Munson Healthcare

Utilization Review Specialist (RN) - Hybrid in Traverse City, MI

Company Description More Than Just Care, It’s Community Imagine doing meaningful work in a place where people vacation. That’s life at Munson Healthcare - northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents across 29 counties. If you want a career in healthcare and a lifestyle most people only dream about – with freshwater lakes, scenic trails, charming downtowns, a vibrant arts scene, and endless outdoor adventures -…
Munson Healthcare

Utilization Review Specialist (RN)

Company Description More Than Just Care, It’s Community Imagine doing meaningful work in a place where people vacation. That’s life at Munson Healthcare - northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents across 29 counties. If you want a career in healthcare and a lifestyle most people only dream about – with freshwater lakes, scenic trails, charming downtowns, a vibrant arts scene, and endless outdoor adventures -…
UHS

UTILIZATION - CASE MANAGER (RN/LIC) FT

Responsibilities The Behavioral Health Utilization Management Case Management-Coordinator supports the utilization management process for BH services provided. This position coordinates authorization activities, maintains accurate payer and clinical documentation, monitors authorization timelines, and facilitates communication among clinical teams, payers and revenue cycle departments. The UM coordinator helps ensure that services are reviewed timely, accurately documented, and provided at the…
Northwestern Medicine

Utilization Review RN-UR Casual Rotating Shift

Description **This is a casual position supporting Utilization Review at Catherine Gratz Griffin Lake Forest Hospital. This position is to provide additional staffing coverage for the department and does not have a set schedule. Looking for someone who is able to work weekdays and weekends. Scheduled for this role is 6a to 6p or 6p to 6a. ** The Case Manager, RN (PT) reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and…
Apollo Medical

Home Health Clinical Review Manager (RN)

Clinical Review Manager Compensation: Salary, processed bi-weekly (26 pay periods). Shift Type: Full-time, on-site, Monday - Friday, with participation in on-call rotations. Benefits: 100% Company Paid Premiums for Dental, Vision, & Short-Term Disability Coverage 3 Medical Plan Options with Low Premiums Whole Person Approach Monthly Mobile Device Reimbursement 401(k) with 3.5% Match Long-Term Disability Coverage Voluntary Life Insurance Provided Device PTO Mileage Reimbursement Paid Holidays…
Prime Healthcare

RN Case Manager - Utilization Review

$47.20 - $63.45 / hour
Overview St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the hospital for high quality and compassionate medical care. St. Francis is recognized for its full range of diagnostic and treatment services in specialties including Cardiovascular, Surgical, Orthopedics, Obstetrics, Pediatrics, Behavioral Health, and Emergency…
Prime Healthcare

RN Case Manager - Utilization Review

$47.20 - $63.45 / hour
Overview St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the hospital for high quality and compassionate medical care. St. Francis is recognized for its full range of diagnostic and treatment services in specialties including Cardiovascular, Surgical, Orthopedics, Obstetrics, Pediatrics, Behavioral Health, and Emergency…
MedStar Health

RN Utilization Review Nurse

$89,065 - $162,801 / year
About this Job: General Summary of Position Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most efficient way. This position is remote but must be willing to travel to Washington DC area for regular meetings. Ideal candidate living in the DC, MD or VA area is required.…
Personify Health

Utilization Review Nurse I LVN/LPN

$25 - $30 / hour
Overview: Who We Are Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives. Learn even more about the…
Denver Health

RN Registered Nurse, Utilization - Denver Health Medical Plan (Must Live In Colorado. Weekly On Site Requirement.)

We are recruiting for a mission-driven RN Registered Nurse, Utilization - Denver Health Medical Plan (Must Live In Colorado. Weekly On Site Requirement.) to join our team! We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey. Our Values Respect | Belonging | Accountability | Transparency Department Managed Care Administration * Must live in Colorado * This is a hybrid role with a requirement of being…
Luminis Health

Utilization Management Nurse - Surgical Services POE

$34 - $55 / hour
Position Objective: Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment. Essential Job Duties: 1. Chart Review : Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource utilization; enters clinical review in EPIC; maintains close communication with external reviews, care coordinators, and…
Personal Touch Home Aides of New York

RN Quality Review Manager- Registered Nurse

$90,000 - $105,000 / year
RN Quality Review Manager- Registered Nurse Brooklyn, NY This a full time , in-person position based out of Brooklyn, NY . RN new grads are welcome . Pay: $90, 000- $105, 000/ annually About Us : With over 50 years of dedicated service to our communities, Personal Touch has been a trusted provider of home care. Our priority lies in ensuring exemplary patient care while fostering a supportive and empowering workplace culture for all team members. We are currently seeking compassionate and skilled…
Memorial Health (IL)

Utilization Review Nurse

$35.92 - $57.47 / hour
Under the direct supervision of the Supervisor, Utilization Review and Clinical Documentation Improvement, this role will be responsible for providing clinically based concurrent and retrospective review of inpatient medical records to evaluate the documentation and utilization of acute care services. This includes facilitation of appropriate physician documentation of care to accurately reflect patient severity of illness and risk of mortality. Additionally, this role will be responsible for…
NaphCare, Inc.

PRN Utilization Management Nurse Practitioner (NP)

Overview NaphCare is hiring a PRN, Utilization Management - Nurse Practitioner NP to join our team of medical professionals at the Corporate office in Birmingham , AL. As a Utilization Management - Nurse Practitioner NP , you will review clinical charts to evaluate the medical necessity and appropriateness of off-site specialty visits and also perform case management for hospitalized patients. This is a unique position where you can make a difference to this diverse population of patients with…
NaphCare, Inc.

Utilization Management Nurse Practitioner (NP)

Overview NaphCare is hiring a Full Time, Utilization Management - Nurse Practitioner NP to join our team of medical professionals at the Corporate office in Birmingham , AL. As a Utilization Management - Nurse Practitioner NP , you will review clinical charts to evaluate the medical necessity and appropriateness of off-site specialty visits and also perform case management for hospitalized patients. This is a unique position where you can make a difference to this diverse population of patients…
UHS

RN Central Utilization Review Nurse

Responsibilities Join the Southwest Healthcare Team! About Us: Creating Health and Harmony, Southwest Healthcare is a comprehensive network of care with convenient hospital and ambulatory care/outpatient locations here to serve the Southern California community. With over 6,000 passionate providers and healthcare employees, our shared goal is to provide convenient access to a wide range of healthcare services in a way that benefits you, your family, and the entire community. Southwest Healthcare…
Health & Hospital Corporation

Utilization Review Nurse RN

Division:Eskenazi Health Sub-Division: Hospital Req ID: 26738 Schedule: Full Time Shift: Days Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 327-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus as well as at 10 Eskenazi Health Center sites located throughout Indianapolis. FLSA Status Exempt #EXPRNJob…