• Sr Utilization Review Specialist…

    Houston Methodist (Houston, TX)
    …intensive. This position has achieved an expert level at all objectives delineated in the Utilization Review Nurse and Utilization Review Specialist ... At Houston Methodist, the Sr Utilization Review Specialist Nurse ...to effectively communicate with patients, physicians, family members and co- workers in a manner consistent with a customer service… more
    Houston Methodist (08/26/25)
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  • Complex Care Nurse Manager

    Lawrence General Hospital (Lawrence, MA)
    …and facilitates appropriate discharge plans. + Works in conjunction with Utilization Review Nurse , Social Worker and Clinical Care Leader to ensure ... As the Complex Care Nurse Manager provides evidence-based assessments, tools, information, and...setting with discharge planning, continuing care, care management, and utilization review . + Five years clinical nursing… more
    Lawrence General Hospital (07/15/25)
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  • Cost Containment Analyst

    ICW Group (Lisle, IL)
    …of Workers ' Compensation, Workers ' Compensation Managed Care processes, Utilization Review , Telephonic Nurse Case Management, and Field ... in tracking, resolution gathering, and trending of cost management issues related to bill review , case management and utilization review . + Works closely… more
    ICW Group (09/22/25)
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  • Registered Nurse (RN) Case Manager - OMC…

    Ochsner Health (New Orleans, LA)
    …hospital-based experience in discharge planning, case management or utilization review . **Certifications** Required - Current registered nurse license in ... implement discharge plans based on patient's individualized needs. Registered Nurse (RN) Case Manager - Case Management OMC Jefferson...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
    Ochsner Health (07/30/25)
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  • Utilization Management Nurse

    Access Dubuque (Dubuque, IA)
    …Conduct reviews inclusive of physician referrals, medication reviews, admissions, utilization review updates, investigating alternatives to hospitalization such ... Utilization Management Nurse **Medical Associates** 1...Dental Insurance, etc. **What You Will Be Doing:** + Review requests from providers or members for approval of… more
    Access Dubuque (09/20/25)
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  • Registered Nurse - Utilization

    ERP International (Barksdale AFB, LA)
    **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale ... identification of types ofhealthcare services for which preauthorization or concurrent review will be required.Reviews previous and present medical care practices as… more
    ERP International (09/17/25)
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  • Utilization Review Clinician - ABA

    Centene Corporation (Tallahassee, FL)
    …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida *...teams to review care services related to Applied Behavior Analysis Services… more
    Centene Corporation (08/23/25)
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  • Utilization Review Clinician…

    Centene Corporation (Raleigh, NC)
    …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
    Centene Corporation (09/27/25)
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  • Utilization Review LVN

    Dignity Health (Rancho Cordova, CA)
    …work from home within the Greater Sacramento, CA region.** **Position Summary:** The Utilization Review (UR) LVN uses clinical judgement in providing ... assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review . Responsibilities may...and documents same in 95% of cases. - Supports co- workers to cover needed staffing, training or special projects… more
    Dignity Health (09/18/25)
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  • Utilization Review RN PRN

    Saint Luke's (Kansas City, MO)
    **Job Description​** The Utilization Review RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through utilization ... using clinical guidelines (InterQual). + Complies with CMS regulation regarding utilization review /management. + Obtains and manages insurance authorizations and… more
    Saint Luke's (08/21/25)
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