Utilization Review Nurse Jobs

RN Utilization Review Full-time
Cottage Health

Utilization Management Case Manager

Cottage Health Santa Barbara, CA
$60 - $92 / hour
Job Description Santa Barbara Cottage Hospital seeks a Utilization Management Case Manager for their SBCH Care Management department responsible for the utilization management, quality assurance, and discharge planning activities for assigned services/areas/patients within Cottage Health. Case management activities will result in quality outcomes, optimal care/cost management of services and/or procedures, a high level of customer satisfaction and contribution to an overall value-oriented…
RN Utilization Review Full-time
Health & Hospital Corporation

RN - Utilization Review Nurse

Health & Hospital Corporation Indianapolis, IN
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…
LPN Utilization Review Telehealth Full-time
Personify Health

Utilization Review Nurse-LVN/LPN

Personify Health Remote, OR
$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…
RN Utilization Review
Community First Medical Center

Case Manager - Utilization Review RN

Community First Medical Center Chicago, IL
$43.47 - $53 / hour
Description Under the general direction of the Director of Behavioral Health, the Case Manager – Utilization Review RN provides clinically based case management and utilization review services to support the delivery of high-quality, cost-effective patient care. The RN is responsible for concurrent utilization review, medical necessity determination, denial prevention, discharge planning, care coordination, and resource management across the continuum of care. The Case Manager – Utilization…
LVN Utilization Review Telehealth Full-time
Inland Empire Health Plan

Claims Review Nurse, LVN (Remote)

Inland Empire Health Plan Rancho Cucamonga, CA
$63,897.60 - $83,075.20 / year
Overview: What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Reporting to the Supervisor, Integrated Transitional Care, the Claims Review Nurse, LVN is responsible for conducting timely medical reviews of IEHP facility and professional claims and appeals. The Claims Review Nurse, LVN identifies process improvements in the UM/Claims interface and makes…
RN Utilization Review Med-Surg Full-time
Emanate Health

Quality Review Nurse - Med Surg/DOU - Full Time - Days 8hr FPH

Emanate Health Glendora, CA
$54.63 - $84.67 / hour
Current Emanate Health Employees - Please log into your Workday account to apply Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team that works together to strengthen our communities and grow as individuals. On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United…
RN Utilization Review Full-time
Havenwyck Hospital

Utilization Management Case Manager

Havenwyck Hospital Lake Angelus, MI
Responsibilities HAVENWYCK HOSPITAL (a UHS facility) Havenwyck Hospital is a Joint Commission-accredited and licensed psychiatric hospital, overlooking Lake Galloway in Auburn Hills, Michigan. We specialize in providing comprehensive, compassionate behavioral health services to children, adolescents and adults. It is the ultimate goal of our dedicated staff to build strength, confidence and knowledge within each patient, in hopes that they may continue learning and understanding their needs and…
RN Utilization Review
Lexington Medical Center

Quality Review Specialist-RN

Lexington Medical Center West Columbia, SC
Quality Management - Acute Full TimeDay Shift 8-430 Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina. It was selected by Modern Healthcare as one of the Best Places to Work in Healthcare and was first in the state to achieve Magnet with Distinction status for excellence…
RN Utilization Review Med-Surg Full-time
Emanate Health

Quality Review Nurse - Med Surg/DOU - Full Time - Days 8hr FPH

Emanate Health Glendora, CA
$54.63 - $84.67 / hour
Current Emanate Health Employees - Please log into your Workday account to apply Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team that works together to strengthen our communities and grow as individuals. On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United…
RN Utilization Review Telehealth Full-time
CVS Health

Utilization Management Nurse Consultant (UM) - Work at Home CST Zone

CVS Health
$26.01 - $56.14 / hour
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Utilization Management (UM) Nurse Consultant 100%…
RN Outpatient Manager/Supervisor Utilization Review Outpatient Full-time
L.A. Care Health Plan

Supervisor, Utilization Management RN (Outpatient)

L.A. Care Health Plan Westlake, CA
$102,183 - $163,492 / year
Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (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…
RN Utilization Review Per Diem
MedStar Health

RN Utilization Review- PRN Weekends

MedStar Health Town Center, MD
$42.82 - $71.16 / hour
About this Job: ***This position requires an individual to have acute Utilization Review experience and must be able to work 4 weekend shifts a month. You must also be available to train consistently in-person, which may include some weekday shifts*** 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…
RN Utilization Review Full-time
MaineGeneral Health

Utilization Review Registered Nurse - 40 hours

MaineGeneral Health Augusta, ME
$39 - $68.25 / hour
Job Summary: MaineGeneral Health is seeking an experienced Utilization Review Registered Nurse (RN) to join our collaborative Utilization Review team. If you’re an RN who enjoys using your clinical expertise to support appropriate patient care, navigate medical necessity and reimbursement, and work collaboratively with a multidisciplinary team, we want to hear from you! Our Utilization Review team is a supportive group that works closely together, sharing knowledge and collaborating on clinical…
RN Utilization Review Telehealth
L.A. Care Health Plan

Utilization Management Nurse Specialist RN II

L.A. Care Health Plan Los Angeles, CA
$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…
Surgical Tech Utilization Review Telehealth Full-time
CVS Health

Utilization Management (UM) Nurse Consultant - Work at Home in EST or CST Zone

CVS Health
$29.10 - $62.32 / hour
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Utilization Management (UM) Nurse Consultant 100%…
RN Utilization Review Telehealth Full-time
CVS Health

Utilization Management Nurse Consultant

CVS Health
$32.01 - $68.55 / hour
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Utilization Management is a 24/7 operation and work…
RN Utilization Review Full-time
Aiken Regional Medical Centers

Medical Peer Review Coordinator (RN-Medical Staff Office)

Aiken Regional Medical Centers Aiken, SC
Responsibilities Medical Peer Review RN – Medical Staff Office Aiken Regional Medical Centers, located in Aiken, South Carolina, is a 273-bed acute care facility providing top quality and safe healthcare to the residents of Aiken and surrounding communities since 1917. Aiken Regional Medical Centers has been ranked a top hospital in South Carolina by the American Heart Association for its treatment of heart attack, heart failure and Stroke, and most recently, coronary artery disease.…
RN Utilization Review Telehealth
L.A. Care Health Plan

Utilization Management Claims Review Nurse RN II

L.A. Care Health Plan Los Angeles, CA
$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…
RN Utilization Review Telehealth Full-time
Molina Healthcare

Facility Site Review Nurse (RN) - Remote in CA

Molina Healthcare Long Beach, CA
$76,425 - $139,028 / year
Job Description Job Summary Provides support for clinical facility site reviews. Under the supervision of leadership, uses clinical judgement within appropriate scope to independently conduct reviews and other monitoring activities for primary care providers, specialty care providers, skilled nursing facilities, sub-acute facilities, intermediate care facilities for developmentally disabled and community-based adult services sites, and other network providers. Completes reviews in alignment with…
RN Utilization Review Other
Children's Mercy

Weekend Option Clinical Review Nurse Care Manager

Children's Mercy Kansas City, MO
$37.69 / hour
Thanks for your interest in Children's Mercy! Do you envision finding a meaningful role with an inclusive and compassionate team? At Children’s Mercy, we believe in making a difference in the lives of all children and shining a light of hope to the patients and families we serve. Our employees make the difference, which is why we have been recognized by U.S. News & World Report as a top pediatric hospital, for eleven consecutive years. Children’s Mercy is in the heart of Kansas City – a metro…
RN Director of Nursing Utilization Review Telehealth Full-time
Molina Healthcare

Director, Inpatient Utilization Management (RN)

Molina Healthcare Long Beach, CA
$101,721 - $198,356 / year
JOB DESCRIPTION Job Summary Work Location: California - Ability to work remote, but selected candidate must reside in the state of California. This position requires California RN Licensure. Candidates must have significant IPA delegation experience. Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing,…
RN Home Health Utilization Review Home Health Full-time
St. Peter's Health Partners

Registered Nurse (RN) Coder OASIS Review - Eddy Visiting Nurse and Rehab Association

St. Peter's Health Partners Troy, NY
$36 - $47.52 / hour
Employment Type: Full time Shift: Day Shift Description: Come join the satisfied, long-term staff of this 5 out of 5 Star Agency. There’s not a local agency that compares to us! Eddy Visiting Nurse and Rehab Association has a rewarding opportunity for a per diem, part time, or full time Registered Nurse (RN) CODER/OASIS Reviewer to join our interdisciplinary Home Care team! Flexibility to work remote What you will do: The role of the coding/OASIS position is to code and complete OASIS reviews on…
RN Utilization Review
L.A. Care Health Plan

Utilization Management Admissions Liaison RN II

L.A. Care Health Plan Los Angeles, CA
$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…
RN Outpatient Utilization Review Outpatient
L.A. Care Health Plan

Utilization Management Nurse Specialist RN II (Outpatient)

L.A. Care Health Plan Los Angeles, CA
$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…
RN Utilization Review Home Health Full-time
VNS Health

Utilization Management RN - Utilization Management

VNS Health New York, NY
$85,000 - $106,300 / year
Overview Assesses member needs and identifies solutions that promote high quality and cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state and federal regulations. Delivers timely notification detailing clinical decisions. Coordinates with management, subject matter experts, physicians, member representatives, and…