• Utilization Review Specialist Nurse

    Houston Methodist (Houston, 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 using...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
    Houston Methodist (11/02/25)
    - Related Jobs
  • Medical Bill Review Senior Nurse

    Zurich NA (Schaumburg, IL)
    Medical Bill Review Senior Nurse 127127 Zurich Insurance is currently looking for a **Medical Bill Review Senior Nurse ** to work from our Schaumburg, IL ... standards by adhering to Best Practices and participating in monthly peer review audits. + Ensure legal compliance by following regional, country and/or local… more
    Zurich NA (11/26/25)
    - Related Jobs
  • Staff Nurse - Utilization Review

    Minnesota Visiting Nurse Agency (Minneapolis, MN)
    …may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the ... Nurse issued by the State of Minnesota. **Title:** *Staff Nurse - Utilization Review (ED)* **Location:** *MN-Minneapolis-Downtown Campus* **Requisition ID:**… more
    Minnesota Visiting Nurse Agency (12/03/25)
    - Related Jobs
  • Registered Nurse - Case Review

    STG International (Rockville, MD)
    STGi is currently seeking a Registered Nurse -Case Review Specialist . The position is remote and open to candidates nationwide. JOB SUMMARY: Provides direct ... service delivery with FOH Business Operations team. Serves as a Registered Nurse Case Review Specialist for the case review process to include ensuring… more
    STG International (11/19/25)
    - Related Jobs
  • Utilization Review Nurse

    US Tech Solutions (Chicago, IL)
    …experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff ... policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. +...3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior… more
    US Tech Solutions (10/17/25)
    - Related Jobs
  • Clinical Review Nurse - Prior…

    Centene Corporation (New York, NY)
    …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... care to members + Provides feedback on opportunities to improve the authorization review process for members + Performs other duties as assigned + Complies with… more
    Centene Corporation (12/10/25)
    - Related Jobs
  • Senior Clinical Review Nurse

    Centene Corporation (Jefferson City, MO)
    …on workplace flexibility. **Position Purpose:** Performs a clinical retrospective review and assessment of complex services previously provided to determine ... quality, cost efficiency, and are within compliance. + Performs a clinical review and assessment of relevant complex post-care services by reviewing medical records… more
    Centene Corporation (12/07/25)
    - Related Jobs
  • Utilization Review Nurse

    University of Utah Health (Salt Lake City, UT)
    …appropriateness of admissions with associated levels of care and continued stay review . + Communication to third-party payers for initial and concurrent clinical ... review . + Reviews patient chart to ensure patient continues...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
    University of Utah Health (10/02/25)
    - Related Jobs
  • Lead Clinical Review Nurse

    Centene Corporation (Denver, CO)
    …to identify and implement opportunities for improvement. + Oversees the clinical review of outcomes including creating and editing correspondence letters with the ... and NCQA standards + Provides expert insight and guidance on the clinical review process of correspondence to ensure compliance with all applicable State and Federal… more
    Centene Corporation (12/06/25)
    - Related Jobs
  • Utilization Review Nurse

    Albany Medical Center (Albany, NY)
    …documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and contacts ... Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies.* Facilitates removal of delays and documents… more
    Albany Medical Center (12/03/25)
    - Related Jobs