Employment Type:Part time Shift: Description:The Utilization Review (UR) Nurse has well-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the department by developing and/or maintaining effective and efficient processes
JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes
Its more than a career, its a calling.OK-REMOTE Worker Type:Regular Job Summary:Evaluates the medical necessity and appropriateness of hospital admissions and surgical procedures. Ensures payors receive clinical information to support services provided by hospital. Ensures hospital
JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes
City/StateNorfolk, VA Work ShiftFirst (Days) Overview: Sentara Health Plans is hiring an Utilization Review Nurse/RN- Remote in Virginia Status: Full-time, permanent position (40 hours) Standard working hours: 8am to 5pm EST, M-F Location: Remote in Virginia Job responsibilities: RN Clinician
Hi, were Oscar. Were hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective
Relief, Days Pay range: $27.74 - $41.61 ST. CHARLES HEALTH SYSTEM JOB DESCRIPTION TITLE: Utilization Review Specialist REPORTS TO POSITION: Manager - Utilization Management DEPARTMENT: Utilization Management DATE LAST REVIEWED: August 2025 OUR VISION: Creating America’s healthiest community, together OUR
JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through
Job DetailsJob Location: Huntington Beach Office - Huntington Beach, CA 92647Position Type: Full TimeSalary Range: $34.98 - $42.85 HourlyRemote in California onlyAre you ready to make a lasting impact and transform the healthcare space? We are
Company Description WHO IS GUIDEHEALTH? Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine
Work From Home Work From Home Work From Home, Indiana 46544 The Utilization Review Coordinator performs admission screening for patients in a bed for medical necessity, and reviews for appropriateness of setting and utilization. WHO WE ARE With 11 ministries
Location:Remote - Ohio Department:Utilization Management Weekly Hours:20 Status:Part time Shift:Variable (United States of America) Pay Grade:$32.25 - $47.00 This is a remote position; however, employment is limited to residents of certain U.S. states due to legal, tax,
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective
JOB DESCRIPTION Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday through Friday from 9:30 AM to 6:30 PM CST and requires prior experience in Utilization Management (UM) and the application of MCG
JOB DESCRIPTION This RN will act as a Care Review Clinician supporting our Medicare members who have recently been admitted to this hospital. The Medicare will support them to ensure a successful transition from inpatient to discharge to
Join a team that shares your calling At MultiCare, you’re more than just a job title — you’re part of a team built on trust that cares for each other, our patients and our communities. Belonging
Clinical Member Services Reviewer Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes
Utilization Review Nurse Join Martins Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of people caring for people, Martins Point employees