• Utilization Review RN

    Prime Healthcare (Ontario, CA)
    …of nursing and a current state Registered Nurse license. + Minimum 3 years RN Utilization Manager working for a Health Plan. + At least 3 years of experience ... perform a holistic and comprehensive review of the medical record for the medical necessity, intensity of service and...in utilization review, referrals, authorizations, denials and appeals. + Current… more
    Prime Healthcare (08/08/25)
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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 necessity and level of care...the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs &… more
    Houston Methodist (07/25/25)
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  • Registered Nurse (RN) - Utilization

    Rochester Regional Health (Rochester, NY)
    Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time)Schedule: Monday - ... class as needed. Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a resource on denial… more
    Rochester Regional Health (08/02/25)
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  • Per Diem Care Manager

    MD Anderson Cancer Center (Houston, TX)
    …nursing experience in a hospital or clinic setting, to include experience as a case manager , triage nurse , utilization review nurse , call center ... materials in discharge phone call program and electronic medical record . 2*. Knowledge Acquisition and Management* a. Acquires and...or clinic setting, to include experience as a case manager , triage nurse , utilization review… more
    MD Anderson Cancer Center (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 ... performance improvement of the UR KPI's. Ensures proper and accurate medical record documentation. **Essential Functions** + Reviews new admissions using 3rd party… more
    Community Health Systems (07/12/25)
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  • Manager Utilization Management

    Beth Israel Lahey Health (Burlington, MA)
    …a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for determining ... with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities for improvement… more
    Beth Israel Lahey Health (06/06/25)
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  • Manager , Utilization Review

    Children's Mercy Kansas City (Kansas City, MO)
    …and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient statusing ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome focused… more
    Children's Mercy Kansas City (06/17/25)
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  • Utilization Review Case Manager

    Covenant Health (Nashua, NH)
    …and procedures. + Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all mandatory learning ... Summary Conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed on a nursing unit, to include… more
    Covenant Health (07/30/25)
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  • Utilization Review Case Manager

    Holzer Health System (Gallipolis, OH)
    …under the supervision of the Director of Care Management. Reviews the medical record on a concurrent basis, utilizing criteria accepted and approved by the Medical ... Monitors the plan of care to ensure the efficient utilization of resources. Collaborates with the multidisciplinary team to...A minimum of three years experience as a registered nurse in acute care for adult or pediatric patients… more
    Holzer Health System (07/24/25)
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  • Utilization Review Specialist RN - FT Days

    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 necessity and level of care...this position is able to cover a multitude of utilization review functions through point of entry, observation progression… more
    Houston Methodist (07/29/25)
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