Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance ... Joint Commission Accredited Health care Organizations standards, state statutes governing hospital ...
Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance ... Joint Commission Accredited Health care Organizations standards, state statutes governing hospital ...
Ensure that utilization review practices comply with regulatory standards, including The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and other state or federal regulations ...
Ensure that utilization review practices comply with regulatory standards, including The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and other state or federal regulations ...
Utilization review, care coordination, acute hospital, ER/ICU, audits, data abstraction, quality improvement, HIPAA, Joint Commission preparationRequired experience: 5 years - 6.Experience in Quality ...
Utilization review, care coordination, acute hospital, ER/ICU, audits, data abstraction, quality improvement, HIPAA, Joint Commission preparationRequired experience: 5 years - 6.Experience in Quality ...
Ensure that utilization review practices comply with regulatory standards, including The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and other state or federal regulations ...
Ensure that utilization review practices comply with regulatory standards, including The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and other state or federal regulations ...
Utilization review, care coordination, acute hospital, ER/ICU, audits, data abstraction, quality improvement, HIPAA, Joint Commission preparationRequired experience: 5 years - 6.Experience in Quality ...
Utilization review, care coordination, acute hospital, ER/ICU, audits, data abstraction, quality improvement, HIPAA, Joint Commission preparationRequired experience: 5 years - 6.Experience in Quality ...
Ensure that utilization review practices comply with regulatory standards, including The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and other state or federal regulations ...
Ensure that utilization review practices comply with regulatory standards, including The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and other state or federal regulations ...
Utilization Review * Care Coordination * Discharge Planning * Denials Management * Access Case ... the Joint Commission and consistently updates the Department accordingly * Review Medical ...
Utilization Review * Care Coordination * Discharge Planning * Denials Management * Access Case ... the Joint Commission and consistently updates the Department accordingly * Review Medical ...
Utilization Review * Care Coordination * Discharge Planning * Denials Management * Access Case ... the Joint Commission and consistently updates the Department accordingly * Review Medical ...
Utilization Review * Care Coordination * Discharge Planning * Denials Management * Access Case ... the Joint Commission and consistently updates the Department accordingly * Review Medical ...
Lead and manage a team of utilization review professionals providing guidance, training, and ... Joint Commission, and hospital policies; participates in the risk mitigation, process of ...
Lead and manage a team of utilization review professionals providing guidance, training, and ... Joint Commission, and hospital policies; participates in the risk mitigation, process of ...
Lead and manage a team of utilization review professionals providing guidance, training, and ... Joint Commission, and hospital policies; participates in the risk mitigation, process of ...
Lead and manage a team of utilization review professionals providing guidance, training, and ... Joint Commission, and hospital policies; participates in the risk mitigation, process of ...
Lead and manage a team of utilization review professionals providing guidance, training, and ... Joint Commission, and hospital policies; participates in the risk mitigation, process of ...
Lead and manage a team of utilization review professionals providing guidance, training, and ... Joint Commission, and hospital policies; participates in the risk mitigation, process of ...
Utilization Review * Discipline: RN * Start Date: 07/13/2026 * Duration: 13 weeks * 40 hours per ... Joint Commission Standards * Core Measures & National Patient Safety Goals * ICD-10 Coding * CPT ...
Utilization Review * Discipline: RN * Start Date: 07/13/2026 * Duration: 13 weeks * 40 hours per ... Joint Commission Standards * Core Measures & National Patient Safety Goals * ICD-10 Coding * CPT ...
Current and accurate knowledge of commercial and government payers and Joint Commission regulations/guidelines/criteria related to Utilization Review. * Well-developed knowledge and skills in medical ...
Current and accurate knowledge of commercial and government payers and Joint Commission regulations/guidelines/criteria related to Utilization Review. * Well-developed knowledge and skills in medical ...
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
Utilization Review Care Manager - Registered Nurse - Must have 3-5 years experience
Orlando, FL · Hybrid
... Commission with review requirements for Managed Contracts, Medicare, Medicaid, and Campus related to admission and continued stay approval. • Adheres to Utilization Management Plan.
Utilization Review Care Manager - Registered Nurse - Must have 3-5 years experience
Orlando, FL · Hybrid
... Commission with review requirements for Managed Contracts, Medicare, Medicaid, and Campus related to admission and continued stay approval. • Adheres to Utilization Management Plan.
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
Utilization Review Care Manager - Registered Nurse - Must have 3-5 years experience
Orlando, FL · On-site
... Commission with review requirements for Managed Contracts, Medicare, Medicaid, and Campus related to admission and continued stay approval. • Adheres to Utilization Management Plan.
Utilization Review Care Manager - Registered Nurse - Must have 3-5 years experience
Orlando, FL · On-site
... Commission with review requirements for Managed Contracts, Medicare, Medicaid, and Campus related to admission and continued stay approval. • Adheres to Utilization Management Plan.
Utilization Specialist
Tucson, AZ · On-site
Sierra Tucson is accredited by the Joint Commission and dual licensed as both an Inpatient ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Tucson, AZ · On-site
Sierra Tucson is accredited by the Joint Commission and dual licensed as both an Inpatient ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Tucson, AZ · On-site
Sierra Tucson is accredited by the Joint Commission and dual licensed as both an Inpatient ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Tucson, AZ · On-site
Sierra Tucson is accredited by the Joint Commission and dual licensed as both an Inpatient ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Commission Optum Utilization Review information
See salary details
$21.39 - $25.72
2% of jobs
$25.72 - $30.05
9% of jobs
$33.01 is the 25th percentile. Wages below this are outliers.
$30.05 - $34.38
21% of jobs
The median wage is $37.88 / hr.
$34.38 - $38.70
23% of jobs
$38.70 - $43.03
13% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$43.03 - $47.36
10% of jobs
$47.36 - $51.68
8% of jobs
$51.68 - $56.01
5% of jobs
$56.01 - $60.34
5% of jobs
$60.34 - $64.66
2% of jobs
$64.66 - $68.99
2% of jobs
$21
$42
$68
How much do commission optum utilization review jobs pay per hour?
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$59.13/hr
Other
Medical, Retirement
Posted 20 days ago
University Medical Center Of Southern Nevada rating
7.2
Based on 16 frontline employees who took The Breakroom Quiz
394th of 1,004 rated hospitals
Job description
Position Summary EMPLOYER-PAID PENSION PLAN (NEVADA PERS) COMPETITIVE SALARY & BENEFITS PACKAGE As an academic medical center with a rich history of providing life-saving treatment in Southern Nevada, UMC serves as the anchor hospital of the Las Vegas Medical District, offering Nevada's highest level of care to promote successful medical outcomes for patients. UMC is home to a Level I Trauma Center, Verified Burn Center, and Transplant Center. In 2026, we became the FIRST and ONLY Magnet-Recognized hospital in the state, reflecting UMC's nursing professionalism, teamwork, and superiority in patient care.
***Per Diem Opening(s)*** THIS POSITION MAY CLOSE WITHOUT NOTICE ONCE A SUFFICIENT NUMBER OF QUALIFIED APPLICATIONS ARE RECEIVED. Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with third party payer requirements. Duties include analyzing medical charts, determining whether care provided is within established parameters.
Job Requirement Education/Experience: Graduation from an accredited school of nursing and five (5) years of acute hospital clinical nursing experience, one (1) year of which was in Utilization Management, Case Management, or Clinical Documentation Improvement. Licensing/Certification Requirements: Valid license by the State of Nevada to practice as a Registered Nurse. Additional Position Requirements Minimum three (3) years of Utilization Management experience.
Minimum of three (3) year's experience with discharge planning in an acute care facility. Recent documented experience with InterQual, and ability to pass the InterQual exam. Recent documented experience with Milliman experience.
Knowledge, Skills, Abilities, and Physical Requirements Knowledge of: Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies and procedures; Joint Commission Accredited Health care Organizations standards, state statutes governing hospital services and health care, and other relevant regulations and standards; clinical medical and nursing procedures; disease processes; department and hospital safety practices and principles; patient rights; age specific patient care practices; infection control policies and practices; department and hospital emergency response policies and procedures. Skill in: Interpreting patient charts to determine whether care given is within best practice, appropriate for the diagnosis and properly documented; excellent ability to collaborate, co-ordinate and communicate findings; interpreting regulations and standards for others; writing reports, meeting minutes and other technical documents; analyzing statistical and other quantitative data; applying investigative and interviewing techniques; using a computer and a variety of software applications; communicating with a wide variety and establishing interpersonal relationships to interact effectively with co-workers, supervisor, staff in other work units and exchange or convey information. Physical Requirements and Working Conditions: Mobility to work in a typical office setting and use standard equipment, stamina to remain seated for extended periods of time, vision to read printed materials and a computer screen, and hearing and speech to communicate effectively in person and over the telephone.
Strength and agility to exert up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. May work shifts and weekends. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this classification.
What University Medical Center Of Southern Nevada employees say
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About University Medical Center of Southern Nevada
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Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Las Vegas, NV, US
Year founded
1931