Encompass Health is seeking Registered Nurses inspired by the prospect of caregiving as it should be, offering a flexible schedule, the latest technology, and a wide range of opportunities. This role involves building relationships, enjoying the rewards of helping people return to their lives, and working in a rehab hospital environment. The company values nurses at all stages of their career and offers a comprehensive benefits package from day one.

Registered Nurse

The Utilization Review Nurse is responsible for the review of precertification admission and concurrent reviews for the appropriateness of the inpatient setting utilizing InterQual criteria. This role involves entering or referencing data via PC, collaborating with facilities, providers, and Medical Directors, and requires excellent written and oral communication skills. The position is remote, with a work location in Detroit, MI, and is a 10-month contract job type.

Utilization Review Nurse

As a Utilization Review RN at Ascension Seton Northwest, you will provide healthcare services related to admissions, case management, discharge planning, and utilization review. This role involves reviewing admissions and service requests for medical necessity and compliance with reimbursement policy criteria, providing case management and consultation for complex cases, assisting with coding, medical records, precertification, reimbursement, and claim denials/appeals, and overseeing compliance to utilization management rules and regulations.

Utilization Review RN - Utilization Review

Utilization Review RN

The Case Management Utilization Review Registered Nurse at Steward Health Care is responsible for documenting medical necessity for inpatient status or placement in observation, communicating with physicians and clinicians, and ensuring timely clinical information is sent to payors for authorization. This role involves coordinating with allied health professionals to ensure quality care and outcomes, developing physician profiles for utilization patterns, and optimizing inpatient length of stay and resource utilization.

Case Management Utilization Review RN - REMOTE - Utilization Review

Case Management Utilization Review Registered Nurse

The Utilization Management Nurse Reviewer (RN) serves as the Subject Matter Expert for patient admission status (inpatient and observation) at Wooster Community Hospital. This role involves working with Providers, Case Management, and the Revenue Cycle team to ensure appropriate admission status, protecting the financial interests of the organization by ensuring the UM review cycle is successfully completed, and tracking and trending payer issues. The position is remote but must be within a 4-hour drive of the hospital.

Utilization Management Nurse Reviewer - FT

Utilization Management Nurse Reviewer

As a Registered Nurse at Encompass Health, you will be the connection between compassionate care and the real, positive results patients are striving to achieve. You'll use your skills within our inpatient rehabilitation setting to provide the nursing perspective and attention to detail that our highly specialized, integrated team approach requires. This role offers the opportunity to work alongside patients on their road to recovery from various conditions, forming significant relationships and celebrating their successes.

The Registered Nurse - Utilization Review at Ascension St. Vincent's Birmingham is responsible for providing health care services regarding admissions, case management, discharge planning, and utilization review. This role involves reviewing admissions and service requests for medical necessity, providing case management for complex cases, assisting staff with coding, documentation, and reimbursement issues, and overseeing compliance with utilization management rules. The position requires at least 3 years of acute care experience and utilization management experience.

Registered Nurse RN - Utilization Review  PRN

Registered Nurse - Utilization Review

A large healthcare insurance company local to the Philadelphia area is seeking a fully remote Case Management RN to join their Care management team. The role involves telephonic or onsite review of hospital admissions, determining alternative settings when appropriate, promoting efficient and high-quality use of the healthcare delivery system, and facilitating timely and dynamic discharge planning. The RN will collaborate with the hospital utilization review department, attending physicians, and members/families as appropriate.

Utilization Management RN - REMOTE (PA, NJ, DE)

Utilization Management Registered Nurse

Pine Park Health is seeking a Registered Nurse to join their team, focusing on providing primary care to residents of senior living communities. The role involves collaborating with a multidisciplinary team, triaging communications, supporting care team members, engaging in comprehensive chart preparation, overseeing post-appointment processes, conducting virtual patient assessments, and participating in quality improvement initiatives. The ideal candidate will have at least 2 years of clinical experience, preferably in geriatrics, and strong experience in remote roles.

Registered Nurse - Remote - Med Surg

Registered Nurse - Med Surg

The Registered Nurse - Review Analyst at W3R Consulting will perform prospective, concurrent, and retrospective review of inpatient, outpatient, ambulatory, and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service, and level of care, including appeal requests initiated by providers, facilities, and members. This role may also involve establishing care plans and coordinating care through the healthcare continuum, including member outreach assessments.

Registered Nurse - Review Analyst

The Utilization Review Clinician at Monte Nido is responsible for conducting utilization reviews, peer reviews, and pre-certifications in a comprehensive manner, documenting these reviews, and coordinating with the clinical team, admissions, verifications, and billing regarding clients' insurance status. This is a remote role aligned to Eastern Time hours, offering a comprehensive benefits package.

Utilization Review Clinician

The Utilization Review Clinician - Retrospective at Centene Corporation performs a post-service retrospective review of member medical records to assess care related to behavioral health, determining if the level of care and services were appropriate. This role involves reviewing medical records for medical necessity, consulting with senior management and healthcare providers for discrepancies, and providing feedback to improve the review process. The position is remote but requires residency in the state of Ohio.

Utilization Review Clinician - Retrospective

As a Utilization Review Nurse at R1 RCM, you will perform initial admission and continued stay reviews utilizing InterQual or Milliman to identify and support the appropriate level of care. This role involves determining appropriate cases for review, ensuring appropriate orders and clinical documentation are in place, and adhering to established quality, timeliness, and productivity outputs. The position requires experience in a clinical inpatient environment and hospital-based utilization or case management, as well as proficiency in basic computer skills. This is a remote position with a flexed weekday schedule and some weekend requirement.

Utilization Review Author

The Utilization Management Clinician I performs utilization review for medical or behavioral health requests using established criteria, technologies, and tools. This role involves identifying, coordinating, and implementing high-quality, cost-effective alternatives for patient care, supporting physician decision-making, and ensuring timely access to care during transitions. The position is fully remote and available across Washington, Oregon, Idaho, Texas, and Florida.

Utilization Management Clinician I - RN or LPN

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Utilization Review Nurse Jobs in Osceola, AR Hiring Now

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