Utilization Review Nurse Jobs

Utilization Review NurseLeave Your Mark

This role involves performing utilization management and review for a Michigan health plan client, working within their systems and evidence-based clinical criteria.

Under the direct supervision of the Supervisor, Utilization Review and Clinical Documentation Improvement, the Utilization Review Nurse provides clinically based concurrent and retrospective review of inpatient medical records to evaluate the documentation and utilization of acute care services.

Utilization Review NurseTRISTAR RISK MANAGEMENT

This role involves performing Workers' Compensation utilization review, including prospective, concurrent, expedited, and retrospective reviews to determine the medical necessity and appropriateness of requested medical care using evidence-based criteria.

Utilization Review NurseTristar Insurance

This nursing role focuses on performing utilization reviews for Workers' Compensation cases, including prospective, concurrent, expedited, and retrospective reviews to determine the medical necessity and appropriateness of requested care.

Utilization Review NurseMemorial Health

This nursing role focuses on the clinical review of inpatient medical records to assess documentation and the use of acute care services.

Utilization Review NurseUnited Staffing Associates

This Utilization Review Nurse position involves evaluating the medical necessity and appropriateness of inpatient care, including making initial clinical approval determinations.

Supporting the health plan's utilization management and prior authorization functions is the core of this nursing role. This includes inpatient care, outpatient services, medications, and durable medical equipment.

Nurse Utilization ReviewMidland Health

This role focuses on maximizing the quality and cost efficiency of healthcare services by ensuring patients receive necessary care without unnecessary procedures or extended hospital stays.

Utilization Review NurseGold Coast Health Plan

This nursing role focuses on reviewing requests for medical services against national clinical guidelines to ensure high-quality, cost-efficient medical outcomes for enrollees.

Utilization Review NurseUT Southwestern

This nursing role focuses on conducting medical certification reviews for acute care facilities and services, ensuring medical necessity using evidence-based guidelines.

Utilization Review NurseRising Medical Solutions

Performing utilization review to help reduce healthcare claim costs is the core of this nursing role. The position involves reviewing medical records, applying evidence-based guidelines, and collaborating with various parties to authorize or refer cases for physician review.

Utilization Review NurseSPECTRAFORCE

This Utilization Review Nurse position is for a Registered Nurse on the Facility Compliance Review team, focusing on post-service prepayment facility claims.

Utilization Review NurseAurora Health Care

This nursing position focuses on utilization review activities, ensuring timely documentation and accurate concurrent and retrospective reviews based on established criteria.

Utilization Review NurseNetsmart

This nursing role focuses on utilization review for emergency admissions and ongoing patient stays. The nurse will evaluate medical records, apply clinical guidelines, and communicate with physicians to ensure appropriate healthcare resource utilization.

This Utilization Review / Discharge Planner Nurse position involves assessing the appropriateness of medical services and planning for patient discharge. The role is for a nurse with experience in utilization review and discharge planning.

Utilization Review NurseBrundage Group

This nursing role involves conducting admission and continued stay reviews to ensure appropriate utilization of hospital resources and compliance with medical necessity criteria, payer requirements, regulatory standards, and organizational policies.

Utilization Review NurseKrungthai AXA Life Insurance Public Company Limited

This nursing role focuses on ensuring appropriate patient care in a hospital network by performing concurrent reviews of clinical information and coordinating discharge planning.

Utilization Review NurseUMC

This nursing role involves reviewing patient admissions to ensure they are appropriate, resources are used efficiently, and third-party payer requirements are met.

Utilization Review NurseNETPACE Health

This contract position is for a Utilization Review Nurse to work a day shift, ensuring appropriate healthcare resource utilization. The role involves reviewing patient cases to determine the medical necessity and appropriateness of care.

Utilization Review NursePride Health

This fully remote opportunity is for an experienced Registered Nurse (RN) with a strong background in health plan or payer-side Utilization Management (UM), prior authorization, and clinical quality review.

Utilization Review NurseAIA

This nursing role focuses on ensuring optimal patient journeys and cost-effective care by acting as a clinical liaison with partner hospitals.

This 13-week contract opportunity in California is for an experienced Utilization Review Nurse (RN) with the potential for a permanent position. The role involves reviewing patient medical records and clinical documentation to ensure medical necessity and appropriateness of care.

Utilization Review NurseAdvocate Aurora Health

This night-shift post on the cardiac ward pairs patient care with mentoring new nurses. The Utilization Review Nurse documents utilization review activity, performs concurrent and retrospective reviews, and communicates effectively with the healthcare team.

Utilization Review NurseTRISTAR

This nursing role focuses on performing Workers' Compensation utilization reviews, including prospective, concurrent, expedited, and retrospective assessments to determine the medical necessity and appropriateness of requested medical care.

Utilization Review Nurse - RNSinging River Health System

This Utilization Review (UR) Nurse role ensures patient care services meet medical necessity criteria and align with appropriate levels of care. The UR Nurse performs concurrent and retrospective reviews to evaluate the appropriateness, quality, and efficiency of care based on clinical presentation…

Utilization Review Nurse (USRN)Private Advertiser

This nursing role involves performing medical necessity reviews for a US healthcare client, covering prospective, concurrent, and retrospective cases. The nurse will review various treatments, procedures, hospitalizations, and care plans to ensure quality and cost-effective care.

Utilization Review Nurse (RN)Madera Community Hospital

This nursing role assesses, plans, implements, and evaluates the needs of patients for discharge planning and utilization review. The nurse coordinates discharge planning with physicians, nursing staff, patients, and their families, and applies knowledge of criteria for various…

Hospice Utilization Review NurseJOL HEALTHCARE

Evaluating the medical necessity, appropriateness, and efficient use of hospice services is the core of this role, ensuring that care delivery aligns with regulations and agency policy.

Registered Nurse - Utilization ReviewOwensboro Health Regional Hospital

This night-shift role as a Registered Nurse in Utilization Review focuses on ensuring cost-effective, quality patient outcomes and smooth transitions. It involves determining appropriate levels of care and offering guidance, education, and support to patients.

Utilization Review Nurse USRNCognizant

Utilizing management nurses are crucial for ensuring quality healthcare support and positive patient outcomes. This role involves conducting utilization management reviews, evaluating medical necessity, and ensuring compliance with regulatory standards.

Utilization Review Registered NurseBayCare

The Utilization Review Registered Nurse serves as the primary liaison between funding agents and related parties, ensuring appropriate levels of care through comprehensive concurrent reviews for medical necessity of outpatient observation and inpatient stays.

Utilization Review Nurse - RNWollborg Michelson Recruiting

This Senior Utilization Management Nurse role involves reviewing facility claims for contract compliance, billing accuracy, medical necessity, and hospital-acquired conditions.

RN Utilization Review NurseSouthwest Healthcare

This full-time RN Central Utilization Review Nurse position is based in the Southwest Healthcare Regional office in Temecula, CA. The role involves carrying out utilization management functions by planning, coordinating, and managing patient needs during hospitalization and throughout the continuum…

Utilization Review NurseMedix™

This remote nursing role is for a Registered Nurse who wants to transition into or grow their career in Utilization Review. It is an opportunity for nurses with acute care experience who enjoy clinical decision-making, medical necessity reviews, and collaborating with providers to…

Utilization Review NurseMedix

This fully remote role involves conducting medical necessity and utilization reviews for inpatient admissions, observation cases, and continued hospital stays.

Registered Nurse, Utilization ReviewShearwater Health

This U.S.-licensed clinician performs utilization management and review for a Michigan health plan client under Shearwater Health's domestic onshore service offering.

This remote nursing role focuses on utilization review for managed care members in skilled nursing facilities. It involves evaluating medical necessity, coordinating care, and ensuring appropriate service utilization. The position suits a licensed nurse with strong SNF experience.

Utilization Review NurseAmerican Health Plans

The Utilization Review Nurse assesses the medical necessity and quality of healthcare services by conducting pre-service, concurrent, and retrospective utilization management reviews.

Utilization Review Nurse - PalliativeVIA Health Partners

This role as a Palliative Utilization Review Nurse involves evaluating and re-evaluating patient and family needs and conditions to support appropriate care decisions.

Staff Nurse (Utilization Review)Veterans Health Administration

This Staff Nurse position focuses on utilization review, ensuring that services provided to Veterans receive approval from third-party payers. The role involves clinical reviews, patient advocacy, and collaboration with clinical and revenue staff.

Utilization Review Nurse - InfusionOklahoma Arthritis Center

This nursing role focuses on evaluating medical records and clinical data to ensure healthcare services are medically necessary and cost-effective, aligning with regulatory and payer requirements.

Utilization Review Registered NurseBJC HealthCare

Reviewing hospital admissions for medical necessity and ensuring appropriate, efficient administration of hospital resources are the core functions of this role.

This role involves assessing patient records to ensure the legitimacy of admissions, treatments, and hospital stays, aligning with government and insurance reimbursement policies.

This specialist role focuses on obtaining and maintaining insurance authorizations for clients receiving substance use disorder treatment.

Utilization Review NurseState of Connecticut, Department of Mental Health and Addiction Services

This full-time nursing role involves assessing and auditing medical records to ensure quality of care and appropriate service levels for clients.

This remote California-based role is for an experienced Registered Nurse to perform concurrent reviews, assess overall member health, and determine the appropriate level of care.

Remote Clinical Review Nurse UtilizationCentene

This remote role involves performing concurrent reviews, assessing care necessity, and contributing to discharge planning for members in Pennsylvania. It suits a Clinical Review Nurse with experience in case management or utilization management who is looking to impact patient care across the…

Registered Nurse PHRN Utilization ReviewAccess Healthcare

This role involves joining a team as a Utilization Review Nurse, focusing on reviewing medical records and clinical documentation. It suits Philippine Registered Nurses with strong clinical knowledge and attention to detail, who have experience with healthcare documentation.

Nurse Utilization Review Specialist IIIUK St. Claire

This specialist role involves evaluating newly admitted patients to ensure appropriate hospitalization, accurate documentation, and correct level of care designation.

Registered Nurse - Utilization Review, PRNSaint Joseph Health System

This night-shift post on the cardiac ward pairs patient care with mentoring new nurses. Responsibilities Conduct clinical reviews of patient records to evaluate medical necessity, appropriateness of admission, treatment, and length of stay across all payor types Apply standardized…