- Actalent (St. Louis, MO)
- Remote Clinical Review Nurse - Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full‑Time About the Role ... We are seeking an experienced Registered Nurse to join our team within a leading Managed...independently in a fast‑paced environment. Key Responsibilities + Conduct clinical reviews of prior authorization requests for… more
- Evolent (Lansing, MI)
- …the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as...I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools… more
- UCLA Health (Los Angeles, CA)
- …related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established ... Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role...and efficient utilization of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to… more
- Baystate Health (Springfield, MA)
- …Minimum - Midpoint - Maximum $87,859.00 - $100,984.00 - $119,412.00 **UM Outpatient Clinical Review Nurse - Baystate Health, Health New England** **This ... **Current States Eligible MA and CT** The **UM Outpatient Clinical Review Nurse ** contributes to...Medicaid strongly preferred + Highly developed critical thinking skills- prior nursing experience ICU or ER + Computer literacy… more
- Centene Corporation (Jefferson City, MO)
- …administered with quality, cost efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical records against ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical retrospective review of services previously provided to determine… more
- University of Utah (Salt Lake City, UT)
- Details **Open Date** 11/19/2025 **Requisition Number** PRN43626B **Job Title** PS Clinical Nurse Specialist **Working Title** PS Clinical Research Nurse ... responsibilities and qualifications required of employees assigned to the job. The Clinical Nurse Specialist makes decisions independently and in collaboration… more
- State of Colorado (Pueblo, CO)
- NURSE III - Clinical Specialist - Pueblo Regional Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5186234) Apply NURSE III - ... minimum staffing standards. This includes covering as a team nurse as needed. This position exists as a unit...and Health Care Technicians/QMAP. + Through direct observations and review of documentation determines if nurses are practicing critical… more
- YAI (Brooklyn, NY)
- …disabilities and their families. Key/Essential Functions & Responsibilities: + Report to the nurse manager or nurse supervisor, at Premier HealthCare (PHC). Meet ... on a weekly basis for supervision to review duties and responsibilities. + Accountable for the day-to-day...and followed as directed. + Assume duties of the nurse supervisor when needed and provide coverage for and… more
- Veterans Affairs, Veterans Health Administration (Smyrna, TN)
- …functions, and the integration of VHA and industry best standards. The Revenue Utilization review (RUR) Registered Nurse (RN) is an active member of the revenue ... clinical denials for revenue. Performs legal case relatedness review for revenue billing purposes. Provides education to VA...Nursing may have opportunity to become registered as a nurse with a state licensing board prior … more
- University of Utah (Salt Lake City, UT)
- Details **Open Date** 12/17/2025 **Requisition Number** PRN16627N **Job Title** PS Clinical Nurse PRN **Working Title** PS Clinical Nurse PRN **Career ... Rate Range** 44.10 per hour **Close Date** 03/17/2026 **Priority Review Date (Note - Posting may close at any...College of Nursing is seeking a compassionate and skilled Clinical Registered Nurse to join our team… more
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