• Registered Nurse (RN) - Utilization…

    Monroe County, NY (Rochester, NY)
    Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit Location: Rochester, NY Title: Registered Nurse (RN) - Utilization ... Hospital Description of Duties This position is in the Utilization Review Unit and functions as an...and works under the general supervision of a Nurse Manager , or other higher-level staff member. General supervision may… more
    Monroe County, NY (08/02/25)
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  • Case Manager Utilization…

    Beth Israel Lahey Health (Burlington, MA)
    …in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse (RN) Case Manager ... Leads the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review...staffs. -Case Manager experience as well as Utilization Review experience ( review medical… more
    Beth Israel Lahey Health (05/11/25)
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  • Registered Nurse - Utilization…

    Beth Israel Lahey Health (Plymouth, MA)
    …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established… more
    Beth Israel Lahey Health (05/17/25)
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  • Manager - Utilization Review…

    Beth Israel Lahey Health (Plymouth, MA)
    …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... **Join Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff… more
    Beth Israel Lahey Health (07/29/25)
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  • Utilization Review…

    Community Health Systems (Naples, FL)
    **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition ... improvement programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. + Performs… more
    Community Health Systems (07/12/25)
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  • Manager , Utilization Review

    Children's Mercy Kansas City (Kansas City, MO)
    …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based...+ One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire +… more
    Children's Mercy Kansas City (06/17/25)
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  • Registered Nurse (RN) - Utilization…

    Rochester Regional Health (Rochester, NY)
    …able to work independently with minimum direction. + Act as a resource for utilization review stakeholders and assists team members in clinical problem solving. ... Job Title: Registered Nurse IDepartment: Utilization Management Location:...standard UM sources for potential inpatient medical necessity denials. Review patient class in the event manager ,… more
    Rochester Regional Health (08/02/25)
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  • Utilization Review Case…

    Covenant Health (Nashua, NH)
    …and procedures. + Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all mandatory ... + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to maintain current knowledge...to work remotely as needed Education and Experience + Registered Nurse licensed in New Hampshire required + Minimum… more
    Covenant Health (07/30/25)
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  • Care Manager RN - PAMC Case Management…

    Providence (Anchorage, AK)
    …Medical Surgical or Inpatient setting + IRR or annual competency testing in Utilization Review **Preferred Qualifications:** + Bachelor's Degree in Nursing or ... **Description** The Inpatient Registered Nurse (RN) Care Manager provides...+ 1 year of experience in care management or utilization review in any setting or successful… more
    Providence (08/01/25)
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  • Per Diem RN Case Manager…

    Children's Hospital Boston (Boston, MA)
    …Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard ... experience required, pediatric experience preferred. + Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred. Licensure/… more
    Children's Hospital Boston (06/16/25)
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