• Sr Utilization Review

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) responsible for ... Utilization Review Nurse and Utilization Review Specialist Nurse...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
    Houston Methodist (08/26/25)
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  • Utilization Review Specialist

    BriteLife Recovery (Englewood, NJ)
    What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is ... responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD)… more
    BriteLife Recovery (09/02/25)
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  • RN Utilization Review

    HonorHealth (AZ)
    …different here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors ... Degree in Nursing from an accredited NLN/CCNE institution RequiredExperience3 years Registered Nurse in an acute care setting. Required1 year… more
    HonorHealth (09/10/25)
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  • RN Utilization Review Remote

    HonorHealth (AZ)
    …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... Nurse in an acute care setting - Required Licenses and Certifications + Registered Nurse ( RN ) State And/Or Compact State Licensure - Required +… more
    HonorHealth (09/26/25)
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  • PRN UR Clinical Specialist

    Community Health Systems (Franklin, TN)
    **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services ... healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence...regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse -… more
    Community Health Systems (09/18/25)
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  • RN Care Manager (Inpatient) - 1.0 FTE

    St. Peters Health (Helena, MT)
    …and utilization review over-site. 1. Utilization Review Specialist : receives information from the RN assigned to the ED related to admission ... with the patient/family, physicians, and the interdisciplinary team, the Case Management/ Utilization Review RN facilitates the patient's progress… more
    St. Peters Health (09/20/25)
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  • Mission Control RN Tier1 Transfer Center FT…

    AdventHealth (Orlando, FL)
    …Services in the verification process. Obtains pre-authorization and provides information to the Utilization Review Specialist , Utilization Review ... Control RN Tier 1 is a professional registered nurse functioning withing Mission Control in...and placement of all patients. Proactively initiates steps, including utilization of the hospital and physician chain of command,… more
    AdventHealth (09/24/25)
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  • Director of Care Management

    Children's Mercy Kansas City (Kansas City, MO)
    …Oversees and directs the work of Nurse Case Managers, Social Workers, and Utilization Review specialist team members and support staff + Analyzes, ... and related software applications and implementations. + Engages in utilization review committee. Qualifications + Master's Degree...Performance Improvement Leadership + One of the following: Licensed RN - MO, Registered Nurse more
    Children's Mercy Kansas City (08/29/25)
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  • Denials Management Specialist

    St. Luke's University Health Network (Allentown, PA)
    …near vision, visual monotony. EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state ... ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for...experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment… more
    St. Luke's University Health Network (08/19/25)
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  • Registered Nurse ( RN )…

    Texas Health Resources (Arlington, TX)
    Registered Nurse ( RN ) - Case...and continuity of care to prevent readmission. 35% C. Utilization Review : 1. Performs utilization ... Years in an acute care setting, case management or utilization review Req 1 Year of acute...acute case management/discharge planning experience Pref Licenses and Certifications RN - Registered Nurse Upon… more
    Texas Health Resources (08/29/25)
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