- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Community Health Systems (Naples, FL)
- …401k match & more available for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews hospital admissions, extended stays, ... Join us as a **Registered Nurse (RN) - Utilization Review...providers and staff to drive compliance with utilization policies. The UR Nurse also contributes… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional...utilization and denial management. Liaises with provider office staff and facilitates meetings with payers, as appropriate *… more
- UTMB Health (Webster, TX)
- …in research activities/projects + Provides assistance regarding clinical issues to non-nursing utilization review staff + Demonstrates support of the ... Utilization Review Case Mgr - CMC...+ Functions as a resource to physicians and nursing staff regarding approved criteria, specialty practice guidelines, and alternative… more
- Community Health Systems (Franklin, TN)
- …a key contact for facility staff and insurance representatives regarding utilization review concerns. + Supports training initiatives within the department ... **Job Summary** The Part-Time Clinical Utilization Review Specialist is responsible for...confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Prime Healthcare (Weslaco, TX)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/233537/registered- nurse -case-manager utilization ... KNAPP MEDICAL CENTER IS LOOKING FOR A PRN REGISTERED NURSE CASE MANAGER TO WORK WEEKENDS. WE OFFER: +...More than 300 physicians serve on the hospital's medical staff . Knapp also serves as one of the largest… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based...families we serve, as well as the Children's Mercy staff , we want to let you know that the… more
- Dignity Health (Rancho Cordova, CA)
- …work from home within the Greater Sacramento, CA region.** **Position Summary:** The Utilization Review (UR) LVN uses clinical judgement in providing ... position may be assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review . Responsibilities may include: - Manages… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- State of Indiana (Evansville, IN)
- Utilization Review Coordinator Date Posted: Nov 24, 2025 Requisition ID: 468630 Location: Evansville, IN, US, 47714 Work for Indiana Begin a fulfilling career ... Psychiatric Medicare/Medicaid Hospital. Role Overview : This position serves as the Utilization Review Coordinator within a psychiatric hospital setting. They… more