• Utilization Review Registered…

    Emory Healthcare/Emory University (Atlanta, GA)
    …_development,_ and leadership programs + And more **Description** The ** Utilization Review (UR) Specialist** is a Registered Nurse responsible for conducting ... when necessary, discussions with the provider team and/or Medical Director of UR. + Primary duties and responsibilities: Operational...experience or a minimum of two years of previous utilization review experience. + Licensure - Must… more
    Emory Healthcare/Emory University (08/08/25)
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  • Utilization Management Review

    AmeriHealth Caritas (LA)
    …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
    AmeriHealth Caritas (06/25/25)
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  • Utilization Management Review

    AmeriHealth Caritas (Washington, DC)
    …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Current driver's license required… more
    AmeriHealth Caritas (06/03/25)
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  • Utilization Review Nurse

    US Tech Solutions (Columbia, SC)
    …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... to hire) **Job Description:** + NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral… more
    US Tech Solutions (07/31/25)
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  • RN- Utilization Review

    Ascension Health (Milwaukee, WI)
    …initiatives. + Develop systems and process for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to ... **Details** + **Department:** Utilization Management + **Schedule:** Full Time, Partially Remote...clients. **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date or job transfer… more
    Ascension Health (08/08/25)
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  • Utilization Review Nurse I

    Centene Corporation (New York, NY)
    …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... appropriateness and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review more
    Centene Corporation (08/02/25)
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  • Utilization Management Nurse

    Actalent (Sunrise, FL)
    …UMN assists in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ... Actalent is hiring a Utilization Management Nurse ! Job Description The...on department activities as assigned. Essential Skills + Clinical review + Utilization review +… more
    Actalent (07/29/25)
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  • Director , Utilization Management

    Alameda Health System (Oakland, CA)
    …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
    Alameda Health System (08/08/25)
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  • Utilization Review - Registered…

    Community Health Systems (Naples, FL)
    **Job Summary** Under the direction of the UR Director /Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical ... improvement programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. + Performs… more
    Community Health Systems (07/12/25)
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  • Registered Nurse - Utilization

    ERP International (Barksdale AFB, LA)
    **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale ... co-workers, families, peers, and other health team members. Submits all concerns through Utilization Management Director ; be able to identify, analyze and make… more
    ERP International (06/18/25)
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