• Sr Utilization Review Specialist…

    Houston Methodist (Houston, TX)
    …This position has achieved an expert level at all objectives delineated in the Utilization Review Nurse and Utilization Review Specialist Nurse job roles ... At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is...to department staff in communicating medical information required by external review entities, managed care contractors, insurers,… more
    Houston Methodist (08/26/25)
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  • 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 ... guidelines and evidence-based practice * Quality of Practice*: * Promotes quality through evidence-based utilization review processes and actively contributes… more
    Minnesota Visiting Nurse Agency (10/02/25)
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  • Utilization Review and Nurse

    Idaho Division of Human Resources (Nampa, ID)
    quality care and regulatory compliance. + Engage with treatment teams and external review bodies to support case management and optimize third-party ... Utilization Review and Nurse Educator - SHW...CMS rules-all with the goal of supporting and maintaining high- quality care for our adolescent patients as well as… more
    Idaho Division of Human Resources (09/23/25)
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  • Utilization Review Nurse

    CDPHP (Latham, NY)
    …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... physician-founded, member-focused, and community-based not-for-profit health plan that offers high- quality affordable health insurance to members throughout New York.… more
    CDPHP (09/23/25)
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  • Behavioral Health Utilization Review

    Actalent (Sunrise, FL)
    Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests for ... with the interdisciplinary team, the UMN handles tasks related to utilization review across various specialties, medical treatments, and services. The role involves… more
    Actalent (10/04/25)
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  • 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 ... development and ongoing implementation of QM Work Plan activities. + Improve quality products and services, by using measurement and analysis to process, evaluate… more
    US Tech Solutions (07/18/25)
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  • Utilization Review Nurse

    US Tech Solutions (May, OK)
    …development and ongoing implementation of QM Work Plan activities. . Improve quality products and services, by using measurement and analysis to process, evaluate ... to meet QM objectives Responsibilities: . Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.… more
    US Tech Solutions (07/18/25)
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  • Quality & Patient Safety Specialist…

    Beth Israel Lahey Health (Cambridge, MA)
    …and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret data, and implement quality improvement initiatives to ... Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays...+ Reviews medical records to collect data for reporting quality measures, including both concurrent medical record review more
    Beth Israel Lahey Health (08/08/25)
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  • Utilization Review Nurse

    Albany Medical Center (Albany, NY)
    …America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. * Completes ... Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions and continued stays, and documents… more
    Albany Medical Center (09/12/25)
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  • Registered Nurse (RN) - Quality

    Bon Secours Mercy Health (Paducah, KY)
    …accreditation, and certification surveys in successful completion. + Prepares and submits quality reports as required by external agencies and payors.Facilitates ... improvement committees and projects as needed. + Supports Medical Staff Quality and Peer Review . + Promotes practices that detect, mitigate or prevent harm using… more
    Bon Secours Mercy Health (10/02/25)
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