• Clinical Utilization Review…

    Community Health Systems (Franklin, TN)
    **Job Summary** The Part-Time Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization more
    Community Health Systems (11/15/25)
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  • Utilization Review Specialist Nurse…

    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 entry and ... of the URN, this position is able to cover a multitude of utilization review functions through point of entry, observation progression of care management, concurrent… more
    Houston Methodist (11/02/25)
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  • Utilization Management Specialist

    CareFirst (Baltimore, MD)
    …**PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist , will analyze clinical information, contracts,… more
    CareFirst (10/29/25)
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  • Utilization Management Specialist

    Cleveland Clinic (Cleveland, OH)
    …with one of the most respected healthcare organizations in the world. As a Utilization Management Specialist , you will perform UM activities, such as admission, ... who excels in this role will: + Recommend resource utilization . + Prioritizes and organizes work to meet changing...a minimum of 85% on IRR quarterly. + Complete Utilization Management for assigned patients with a minimum of… more
    Cleveland Clinic (10/18/25)
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  • Utilization Review Specialist - Per…

    Westborough Behavioral Healthcare Hospital (Westborough, MA)
    …a UR Specialist to provide Per Diem coverage. Job Description: The Utilization Review Specialist is responsible for monitoring adherence to the hospital's ... utilization review plan to ensure the effective and efficient...experience. + 2-3 years experience working as a UR Specialist , Medical Billing or health care quality assurance. +… more
    Westborough Behavioral Healthcare Hospital (10/14/25)
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  • Physician Utilization Review…

    Hackensack Meridian Health (Hackensack, NJ)
    **The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... and Hackensack UMC. These include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management, and transitions of… more
    Hackensack Meridian Health (11/12/25)
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  • Utilization Review Specialist

    Hunterdon Health Care System (Flemington, NJ)
    This is an in-person role. Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure the ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
    Hunterdon Health Care System (10/31/25)
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  • Utilization Review Specialist

    Medical Center Hospital (Odessa, TX)
    + Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the hospital ... Utilization Review Program and makes appropriate referrals to designated Physician Advisors. + Qualifications: A. Education: Holds a current Texas license as a… more
    Medical Center Hospital (10/18/25)
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  • Utilization Review Specialist

    WestCare Foundation (Henderson, NV)
    Utilization Review Specialist Job Details Job Location Henderson - 1711 Whitney Mesa - Henderson, NV Position Type Full Time Education Level 2 Year Degree Salary ... or RN and/or Bachelors or Masters level CADC/LADC with 2 years utilization review experience, preferred experience working with individuals with psychiatric or… more
    WestCare Foundation (11/13/25)
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  • Utilization Management Specialist

    Mount Sinai Health System (New York, NY)
    **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing stay.… more
    Mount Sinai Health System (10/03/25)
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