• 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,...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
    Houston Methodist (08/16/25)
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  • Utilization Review Nurse

    The County of Los Angeles (Los Angeles, CA)
    UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply  UTILIZATION REVIEW ... direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one… more
    The County of Los Angeles (06/28/25)
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  • Utilization Review Nurse

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -...a hospital or insurance company providing utilization review services + Knowledge of Medicare , Medicaid,… more
    Houston Methodist (07/25/25)
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  • Registered Nurse 1 Psychiatric (NY Helps),…

    New York State Civil Service (New York, NY)
    Nurse 1 Psychiatric (NY HELPS), New York State Psychiatric Institute, Utilization review , P26749 Occupational Category Health Care, Human/Social Services ... Code 10032 Duties Description The selected candidate will provide Utilization Review services, including but not limited...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
    New York State Civil Service (08/14/25)
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  • Utilization Review Nurse

    US Tech Solutions (Columbia, SC)
    …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... to hire) **Job Description:** + NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral… more
    US Tech Solutions (07/31/25)
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  • Utilization Review Nurse

    US Tech Solutions (Chicago, IL)
    …MANAGED CARE exp and Medicare /Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF UTILIZATION ... with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an...Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
    US Tech Solutions (07/18/25)
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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 the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
    Humana (08/16/25)
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  • Registered Nurse Utilization

    Intermountain Health (Murray, UT)
    …FEHB, Marketplace Qualified Health Plans, fully funded and self-funded Commercial plans. Utilization Review nurses at Select Health proactively oversee inpatient ... and outpatient utilization to assure that care related to health insurance...applicable regulatory guidelines (NCQA, CMS, State) and ensures timely review with clear accurate communication to members and requesting… more
    Intermountain Health (08/15/25)
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  • Utilization Review Nurse

    US Tech Solutions (May, OK)
    …MANAGED CARE exp and Medicare /Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION ... clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews… more
    US Tech Solutions (07/18/25)
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  • Per Diem Registered Nurse II/III…

    Ventura County (Ventura, CA)
    …Under direction, scheduled as needed to assist with patient care coordination and utilization review . The incumbent will be responsible to assist with evaluation ... Per Diem Registered Nurse II/III - Utilization Management VCMC...(TJC), California Department of Health Services (DHCS), Centers for Medicare & Medicaid Services (CMS), and Department of Managed… more
    Ventura County (08/10/25)
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