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UTILIZATION REVIEW SPECIALIST

Oversees all functions of a virtual IOP caseload. Completes peer reviews on cases with insurance. Collaborates at a high level to problem solve on complex cases with Manager. Completes pre-certs and continued stay authorizations f...

CompanyCharlie Health
AddressRemote
CategoryHuman Resources
Salary$61K - $77.2K a year
Job typeFull-time
Date Posted a month ago See detail

Utilization Review Specialist

Charlie Health

Remote

$61K - $77.2K a year

Oversees all functions of a virtual IOP caseload. Completes peer reviews on cases with insurance. Collaborates at a high level to problem solve on complex cases with Manager. Completes pre-certs and continued stay authorizations f...

a month ago seen See more...

Staff Development Specialist in Utilization Review

Reportprep, Inc

Palestine, TX

$45,000 - $75,000 a year

401(k) matching. Dental insurance. Disability insurance. Employee assistance program. Flexible spending account. Health insurance. Health savings account. Life insurance. Paid sick time. Paid time off. Vision insurance. Monday to...

2 months ago seen See more...

Utilization Review Case Manager CMC

Utmb Health

Friendswood, TX

Demonstrates thorough knowledge of Inter Qual Criteria, CMC Specialty Referral Guidelines and Protocols used to determine status for inpatient admission or observation in Community Hospitals and UTMB-TDCJ Hospital. Performs utiliz...

2 months ago seen See more...

Utilization Review RN, Lead - $4,000 Sign-On Bonus

Island Health

Anacortes, WA

Reviews medical records for determination and documentation of medical necessity for inpatient and/or observations status utilizing established criteria and methods.. Identifies issues and variations in utilization and escalates t...

2 months ago seen See more...

Registered Nurse - Utilization Manager

Erp International

Little Rock Air Force Base, AR

Founded in 2006, ERP is headquartered in Laurel, MD and maintains satellite offices in Montgomery, AL and San Antonio, TX - plus project locations nationwide. Performs prospective, concurrent, and/or retrospective utilization revi...

2 months ago seen See more...

Utilization Review RN

Coxhealth

Springfield, MO

5x Modern Healthcare Best Places to work. America's Greatest Workplaces 2023 - Newsweek. Best Employers for New Grads 2023- Forbes. Greatest Workplace for Women 2023 - Newsweek. Robust, fully customizable benefits package includin...

2 months ago seen See more...

Utilization Review Specialist (remote)

Coronis Health

El Paso, TX

$48,000 - $65,000 a year

Act as agency liaison with insurance and managed care companies for authorization of treatment costs, representing company in a positive manner in the professional Participate in staff meetings as needed Clear communication with s...

2 months ago seen See more...

Utilization Review Author

R1 Rcm, Inc.

Remote

$24.00 - $41.68 an hour

Perform initial admission and continued stay reviews utilizing InterQual and MCG using evidenced-based criteria to identify and support the appropriate level of care Abstract data from a variety of medical records to ensure accura...

2 months ago seen See more...

RN Utilization Review- Allegheny Health Network

Highmark Health

Remote - Pennsylvania, United States

Obtains or ensures acquisition of appropriate pre-certifications/authorizations from third party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third party payer...

2 months ago seen See more...

Utilization Review Clinician - Behavioral Health

Centene Corporation

Atlanta, GA

Evaluates member's treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate. Performs prior authorization reviews related to mental health an...

2 months ago seen See more...

Utilization Review RN - Utilization Management Dept OCGMC

Kpc Global Medical Centers Inc.

Santa Ana, CA

$50 - $85 an hour

Coordinates and reviews all medical records, as assigned to caseload. Actively participates in Case Management and Treatment Team meetings Serves as on-going educator to all departments. Responsible for reviewing patient charts in...

2 months ago seen See more...

Utilization Review Specialist

Affinity Recovery

Newport Beach, CA

$65,000 - $75,000 a year

Clinical Record Review: Thoroughly review mental health and substance abuse clinical records. Utilization Determination: Evaluate treatment plans and services for compliance and necessity. Collaboration: Work closely with clinical...

2 months ago seen See more...

UTILIZATION REVIEW SPECIALST (PRN)

Rockford Center

Newark, DE

$71.8K - $91K a year

Completes pre-certs and concurrent reviews as assigned, on appropriate day and by the specified time. Completes write-ups on new admissions and step-downs/step-ups as assigned, along with the Change Level of Care form when appli...

2 months ago seen See more...

Utilization Review (UR) Specialist - Addiction Treatment Program

Renewal Health Group

Los Angeles, CA

Medical, dental, vision, short-term disability, and life insurance. Reimbursement for licensing fees. Education assistance. Employee referral bonus. Healthcare Flexible spending account with $250 company contribution for Full time...

2 months ago seen See more...

RN - LEAD CARE COORDINATOR - Utilization Review

Trinity Health

Maywood, IL

Benefits from Day One. Competitive compensation. Career Development. Tuition Reimbursement. On Site Fitness Center. Educational Stipend. Referral rewards....

2 months ago seen See more...

Physician Utilization Review Specialist

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 clinical records for the patient population and HackensackUMC. These includ...

2 months ago seen See more...

Utilization Review RN

Providence Swedish

Olympia, WA

$40.56 - $83.20 an hour

Upon hire: Washington Registered Nurse License. 3 years Nursing. Bachelor's Degree Nursing Or. Associate's Degree Nursing. 3 years Utilization Review, Care Management, Quality Management, and/or Discharge planning....

2 months ago seen See more...

Care Manager RN – Utilization Review

Providence

Missoula, MT

$36.40 - $57.63 an hour

Graduate of an accredited school of nursing Or. Graduate of an accredited health information technology program. Upon hire: Montana Registered Nurse License. 3 years of experience in Clinical Nursing. Hospital case management expe...

2 months ago seen See more...

Utilization Review Specialist

Delta Specialty Hospital

Memphis, TN

$46.7K - $59.2K a year

Act as liaison between managed care organizations and the facility professional clinical staff. Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coor...

2 months ago seen See more...

Utilization Review Specialist

Pacific Grove Hospital

Riverside, CA

$60.6K - $76.7K a year

Competitive Salary. Paid Time Off. Paid Holidays (8 Total). Medical, Dental, & Vision Insurance. FSA & HSA Plans. Long-Term & Short-Term Disability. Company Paid Life Insurance. Supplemental Life Insurance. Employee Assistance Pro...

2 months ago seen See more...

Utilization Review Coordinator (UR)

Lake Behavioral Hospital

Waukegan, IL

$53,000 a year

Education & Education: Degree in nursing, social work, mental health/behavioral sciences, or related field required; Masters degree preferred. Experience: A minimum of two (2) years experience in a healthcare setting or managed...

2 months ago seen See more...

UR (Utilization Review) Specialist

Sunshine Behavioral Health

Denver, CO

$58,000 - $60,000 a year

Conducts timely; Precertification, Concurrent and Discharge reviews (Peer reviews and eligibility checks as necessary) as well as retro reviews and appeals as needed. Organizes and communicates information necessary to complete da...

2 months ago seen See more...

Utilization Review Advocate

Wecare

Waite Park, MN

$46,000 - $50,000 a year

Monthly audit of client medical coverage to ensure continuation of services. Processes patient authorizations, denials, and appeals. Conduct billing reviews and actively follow up on claims denials to ensure accurate and timely re...

2 months ago seen See more...

Utilization Review Assistant

Clear Behavioral Health

Torrance, CA

$17.50 - $21.00 an hour

A progressive, efficient, and fun place to work. An innovative and highly accomplished place to support mental wellness. The best place to receive cutting-edge and multi-faceted mental health and substance abuse treatment that is...

2 months ago seen See more...

Utilization Review RN

Billings Clinic

Montana, United States

Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days. )*If attending is unable to provide additional clinical information supporting status...

2 months ago seen See more...

Utilization Review Specialist

Tuerk House

Baltimore, MD

$49.3K - $62.4K a year

Maintains documentation of clinical reviews in Utilization Management Portal (OPTUM). Sends thorough reviews to OPTUM and Private insurance as appropriate. Coordinates peer review and notifications, per policy. Collaborates with...

2 months ago seen See more...

Utilization Review RN

Marshall Medical Center

Placerville, CA

$55.77 - $69.71 an hour

Current State of California Registered Nursing License required. Minimum of 2 years nursing experience required, experience in a variety of settings preferred. Experience where leadership, integrity, initiative and effective commu...

2 months ago seen See more...

UTILIZATION REVIEW AND APPEALS RN

Carson Tahoe Health

Carson City, NV

Live, work and play in one of the most beautiful regions in the world Enjoy an array of outdoor activities world class skiing, golf, camping, mountain biking, hiking, water skiing, kayaking, hunting and fishing Just next door is B...

2 months ago seen See more...

Utilization Review Coordinator

Lighthouse Care Center Of Augusta

Augusta, GA

$57.7K - $73K a year

review clinical content of medical records,. participate in treatment team meetings,. collaborate with physicians, therapist, nurses and pertinent staff on gathering the necessary data to communicate with insurance companies/autho...

2 months ago seen See more...

Administrative Secretary, Utilization Review - Weekend Shift

Uc Health

Cincinnati, OH

Assists in mail/order sorting and distribution, faxes, and typing of documents. Photocopies documents as needed by staff. Collects packets of information for various needs. Greets and directs departmental visitors and patients to...

2 months ago seen See more...

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People who searched for Nurse Utilization Review jobs also searched for Nursing Supervisor, Registered Nurse Virtual, Utilization Manager, Private Duty Registered Nurse, Nurses Aide, Clinical Nurse Manager, Nursing Home, Registered Nurse Home Health, Nurse Extern, Nurse Team Lead, Registered Nurse Pcu, Nurse Tech, Ed Registered Nurse, Clinical Nurse Lead, Review Nurse, . If you're getting few results, try a more general search term. If you're getting irrelevant result, try a more narrow and specific term.

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What are the top cities open Nurse Utilization Review jobs?

There are open Nurse Utilization Review jobs in several cities including Santa Rosa, Overland Park, Spencer, New Bern, Grand Junction, Irving, Saint Paul,

What companies are hiring for Nurse Utilization Review jobs?

The top companies hiring now for Nurse Utilization Review jobs are CarolinaEast Health System, Christus Health, DOCS Management Services, HealthBPM, LifeBridge Health, Netsmart, Netsmart Technologies, TLC Nursing, UST - 3.7, Zenex Partners,

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