• Utilization Review Specialist RN…

    Houston Methodist (Sugar Land, TX)
    At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical ...this position is able to cover a multitude of utilization review functions through point of entry,… more
    Houston Methodist (07/29/25)
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  • Utilization Review Nurse…

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... medical record review for medical ...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
    Houston Methodist (07/25/25)
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  • Utilization Review Specialist / RN

    Emory Healthcare/Emory University (Atlanta, GA)
    …mentorship, _development,_ and leadership programs + And more **Description** The ** Utilization Review (UR) Specialist** is a Registered Nurse responsible ... for conducting thorough medical necessity reviews to assist with determining appropriate patient...experience or a minimum of two years of previous utilization review experience. + Licensure - Must… more
    Emory Healthcare/Emory University (08/09/25)
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  • Organ Utilization Coordinator

    LifeCenter Northwest (Bellevue, WA)
    Organ Utilization Coordinator Job Details Job Location Bellevue HQ - Bellevue, WA Position Type Full Time Salary Range $75918.00 - $110112.00 Salary Job Posting ... Date(s) Start Date 08/05/2025 Description and Qualifications The Organ Utilization Coordinator (OUC) is accountable for overseeing all activities related to the… more
    LifeCenter Northwest (08/08/25)
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  • Interim RN Utilization Review

    Ascension Health (Baltimore, MD)
    **Details** + up to $5,062 gross full weekly travel rate + **Department:** Ascension Travel Program & Interim Leadership + **Schedule:** Full-time + ... Please consult with your Recruiter to learn more. Will serve as an Interim Travel Nursing leader with the potential to serve various Ascension hospitals. For more… more
    Ascension Health (07/23/25)
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  • Utilization Management Reviewer

    Commonwealth Care Alliance (Boston, MA)
    …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a ... to the Utilization Management Manager. * Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas,… more
    Commonwealth Care Alliance (07/31/25)
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  • Utilization Management Manager (Hybrid)

    CareFirst (Baltimore, MD)
    …required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership experience. ... **Resp & Qualifications** **PURPOSE:** Manages the utilization of referral services. Enhances quality of care...**Knowledge, Skills and Abilities (KSAs)** + Proficient in standard medical practices and insurance benefit structures. + Proficient in… more
    CareFirst (07/12/25)
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  • Utilization Management Clinical Consultant…

    CVS Health (Columbus, OH)
    …and trainings to New Albany Office in OH. **Preferred Qualifications** + Managed care/ utilization review experience preferred + Experience in a behavioral health ... Summary** The Behavioral Health UM Clinician position is designed to clinically review of behavioral health prior authorized services for assigned members. This… more
    CVS Health (08/09/25)
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  • Utilization Management RN

    Guidehouse (New York, NY)
    …based on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs ... **Job Family** **:** Clinical Appeals Nurse ** Travel Required** **:** None **Clearance Required** **:** None...None **What You Will Do** **:** + Performs chart review of identified patients to identify quality, timeliness and… more
    Guidehouse (07/25/25)
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  • Utilization Management Nurse

    CenterWell (Augusta, ME)
    …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
    CenterWell (08/02/25)
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