• Utilization Management Review

    AmeriHealth Caritas (Washington, DC)
    …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
    AmeriHealth Caritas (06/03/25)
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  • Utilization Management Review

    Humana (Columbus, OH)
    …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
    Humana (08/16/25)
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  • Utilization Review & Chronic Care…

    George C. Grape Community Hospital (Hamburg, IA)
    Utilization Review & Chronic Care Management (CCM) Nurse George C. Grape Community Hospital & Clinics is seeking a full-time Utilization Review & ... this position, you'll split your time between: * Hospital Utilization Review - Conduct daily face-to-face rounds...ensure documentation supports medical necessity. * Clinic Chronic Care Management - Work with patients who have multiple chronic… more
    George C. Grape Community Hospital (08/16/25)
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  • Utilization Review Nurse

    Houston Methodist (The Woodlands, TX)
    At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,...state, local, and federal programs + Progressive knowledge of utilization management , case management , performance… more
    Houston Methodist (07/12/25)
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  • Utilization Management Nurse

    CVS Health (Boise, ID)
    … (RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have ... procedures/services or initiate a Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to… more
    CVS Health (08/15/25)
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  • CSI Analyst (Registered Nurse ) Center…

    Premier Health (Dayton, OH)
    …experience Prior job title or occupational experience: Case management , utilization review , clinical nurse Prior specific functional responsibilities: ... with knowledge and expertise in process analysis, clinical outcome data analysis, utilization management , utilization of information systems and regulatory… more
    Premier Health (08/13/25)
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  • Utilization Review Specialist…

    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 ... this position is able to cover a multitude of utilization review functions through point of entry,...to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of… more
    Houston Methodist (08/16/25)
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  • Insurance Specialist - Samaritan Hospital - PD…

    Trinity Health (Troy, NY)
    …requirements for Utilization Management and works collaboratively with Utilization Management /Concurrent Review Nurse , physicians, staff and ... Upon identification of possible concurrent denials, forwards information to the appropriate Utilization Management /Concurrent Review Nurse within… more
    Trinity Health (07/26/25)
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  • Clinical Review Nurse

    Actalent (Dallas, TX)
    Clinical Review Nurse ( Utilization Management )100% Remote Job Description The role of the Utilization Management Nurse involves performing ... setting of care. Essential Skills + 2+ years of utilization management and utilization review expertise. + Experience in concurrent review and… more
    Actalent (08/08/25)
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  • Utilization Review Nurse

    The County of Los Angeles (Los Angeles, CA)
    …may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience whose primary charge is ... UTILIZATION REVIEW NURSE SUPERVISOR I Print...of Los Angeles, a Utilization Review Nurse is an RN that has Case Management more
    The County of Los Angeles (08/18/25)
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