• Utilization Review Specialist…

    Houston Methodist (Sugar Land, TX)
    At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) who comprehensively ... this position is able to cover a multitude of utilization review functions through point of entry,...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
    Houston Methodist (07/29/25)
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  • Utilization Review Specialist

    Hunterdon Health Care System (Flemington, NJ)
    Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure the effective and efficient ... 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 (06/13/25)
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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 (07/03/25)
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  • RN Utilization Review…

    HonorHealth (AZ)
    …different here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... 1 year experience in UR/UM or Case Management Required Licenses and Certifications Registered Nurse ( RN ) State And/Or Compact State Licensure Required more
    HonorHealth (06/11/25)
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  • Utilization Review Specialist…

    Nuvance Health (Danbury, CT)
    …other duties as required. Education: ASSOCIATE'S LVL DGRE Required: 3 Years of Utilization Review experience(or a certification ACMA, MCG, Interqual) Required : ... one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the...CT Registered Nurse License Working Conditions: Manual: significant… more
    Nuvance Health (07/03/25)
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  • Utilization Review RN

    Catholic Health Initiatives (Omaha, NE)
    …2 hours of a Commonspirit Health Facility Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact ... Review experience.** Medical Coding experience is a plus! As our Utilization Review RN , you will be responsible for conducting comprehensive reviews of… more
    Catholic Health Initiatives (06/21/25)
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  • RN Utilization Management Openings…

    Amergis (Rancho Cordova, CA)
    …Utilization Management. Apply today to learn more about the current opportunities! The Utilization Review Specialist is responsible for theassessment and ... + Current license for the state in which the nurse practicesif nursing licensure is required by contract +...Degree in Nursing or at least two years'experience in Utilization Review preferred + Certification in … more
    Amergis (07/03/25)
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  • 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 (07/29/25)
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  • Manager, Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    …for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized ... reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison...Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization, concurrent… more
    Commonwealth Care Alliance (05/21/25)
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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 (05/31/25)
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