Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of ...
Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of ...
RN Utilization Review Nurse
$33 - $37/hr
Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team. * Identifies appropriate benefits, eligibility, and ...
RN Utilization Review Nurse
$33 - $37/hr
Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team. * Identifies appropriate benefits, eligibility, and ...
Review inpatient admissions to assure appropriate level of care and medical necessity for members. 100% Onsite/Telephonic Review inpatient admissions to assure appropriate level of care and medical ...
Review inpatient admissions to assure appropriate level of care and medical necessity for members. 100% Onsite/Telephonic Review inpatient admissions to assure appropriate level of care and medical ...
Utilization Review Nurse
Plano, TX · Remote
This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and ...
Utilization Review Nurse
Plano, TX · Remote
This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and ...
EO/AA This position is responsible for assisting with the coordination of utilization review, concurrent review and medical necessity review. Provides customer service and interaction with providers ...
EO/AA This position is responsible for assisting with the coordination of utilization review, concurrent review and medical necessity review. Provides customer service and interaction with providers ...
Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum ...
Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum ...
Utilization Review RN
$30 - $32/hr
Are you an experienced Registered Nurse with Utilization Review or Concurrent Review experience looking for a new opportunity with a prestigious Managed Care Company? Do you want the chance to ...
Utilization Review RN
$30 - $32/hr
Are you an experienced Registered Nurse with Utilization Review or Concurrent Review experience looking for a new opportunity with a prestigious Managed Care Company? Do you want the chance to ...
Utilization Review Nurse
Miami, FL · On-site
Concurrent Review & Care Progression * Conducts timely concurrent reviews with hospitals and facilities to assess clinical stability, treatment response, and discharge readiness. * Reviews clinical ...
Utilization Review Nurse
Miami, FL · On-site
Concurrent Review & Care Progression * Conducts timely concurrent reviews with hospitals and facilities to assess clinical stability, treatment response, and discharge readiness. * Reviews clinical ...
Concurrent Review & Care Progression * Conducts timely concurrent reviews with hospitals and facilities to assess clinical stability, treatment response, and discharge readiness. * Reviews clinical ...
Concurrent Review & Care Progression * Conducts timely concurrent reviews with hospitals and facilities to assess clinical stability, treatment response, and discharge readiness. * Reviews clinical ...
Medical Authorization Assistant- Long Term Care
$19 - $24.25/hr
Authorizes requested services according to Concurrent Review team guidelines. Contacts the health networks and/or CalOptima Health Customer Service department regarding health network enrollments.
Medical Authorization Assistant- Long Term Care
$19 - $24.25/hr
Authorizes requested services according to Concurrent Review team guidelines. Contacts the health networks and/or CalOptima Health Customer Service department regarding health network enrollments.
Insurance Denial Specialist
Madera, CA · On-site
Review and resolve authorization denials, medical necessity denials, level-of-care downgrades (inpatient to observation), and concurrent review denials issued by commercial, managed care, Medicare ...
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Insurance Denial Specialist
Madera, CA · On-site
Review and resolve authorization denials, medical necessity denials, level-of-care downgrades (inpatient to observation), and concurrent review denials issued by commercial, managed care, Medicare ...
Calls insurance companies to obtain precertification or concurrent with the level of care. * Attend ... review processes
Calls insurance companies to obtain precertification or concurrent with the level of care. * Attend ... review processes
Medical Authorization Assistant- Long Term Care
Orange, CA · On-site
$24 - $28/hr
Authorizes requested services according to Concurrent Review team guidelines. * Contacts the health networks and/or CalOptima Health Customer Service department regarding health network enrollments.
Medical Authorization Assistant- Long Term Care
Orange, CA · On-site
$24 - $28/hr
Authorizes requested services according to Concurrent Review team guidelines. * Contacts the health networks and/or CalOptima Health Customer Service department regarding health network enrollments.
Insurance Denial Specialist
Madera, CA · On-site
$25 - $32/hr
Review and resolve authorization denials, medical necessity denials, level-of-care downgrades (inpatient to observation), and concurrent review denials issued by commercial, managed care, Medicare ...
Insurance Denial Specialist
Madera, CA · On-site
$25 - $32/hr
Review and resolve authorization denials, medical necessity denials, level-of-care downgrades (inpatient to observation), and concurrent review denials issued by commercial, managed care, Medicare ...
Review and resolve authorization denials, medical necessity denials, level-of-care downgrades (inpatient to observation), and concurrent review denials issued by commercial, managed care, Medicare ...
Review and resolve authorization denials, medical necessity denials, level-of-care downgrades (inpatient to observation), and concurrent review denials issued by commercial, managed care, Medicare ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment ...
The employee conducts admission and concurrent reviews including observation and inpatients, identifies patients who do not meet criteria and takes action to ensure patients are cared for in the most ...
The employee conducts admission and concurrent reviews including observation and inpatients, identifies patients who do not meet criteria and takes action to ensure patients are cared for in the most ...
Calls insurance companies to obtain precertification or concurrent with the level of care. * Attend ... review processes
Calls insurance companies to obtain precertification or concurrent with the level of care. * Attend ... review processes
Care Review Clinician
$33 - $37/hr
Provides daily review and evaluation of members that require hospitalization and/or procedures ... Prior Auth, Concurrent Rev. (6 months)- Identifies appropriate benefits, eligibility, and expected ...
Care Review Clinician
$33 - $37/hr
Provides daily review and evaluation of members that require hospitalization and/or procedures ... Prior Auth, Concurrent Rev. (6 months)- Identifies appropriate benefits, eligibility, and expected ...
Concurrent Review information
See salary details
$15.63 - $19.08
14% of jobs
$21.93 is the 25th percentile. Wages below this are outliers.
$19.08 - $22.53
14% of jobs
$22.53 - $25.98
17% of jobs
The median wage is $27.88 / hr.
$25.98 - $29.44
11% of jobs
$29.44 - $32.89
8% of jobs
$32.89 - $36.34
6% of jobs
$38.93 is the 75th percentile. Wages above this are outliers.
$36.34 - $39.79
7% of jobs
$39.79 - $43.25
7% of jobs
$43.25 - $46.70
5% of jobs
$46.70 - $50.15
5% of jobs
$50.15 - $53.61
5% of jobs
$15
$31
$53
How much do concurrent review jobs pay per hour?
As of Jul 22, 2026, the average hourly pay for concurrent review in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.
What are the key skills and qualifications needed to thrive as a Concurrent Review Nurse, and why are they important?
To thrive as a Concurrent Review Nurse, you need a strong clinical background, current RN licensure, and a thorough understanding of utilization management and healthcare regulations. Familiarity with case management software, electronic health records (EHRs), and knowledge of insurance guidelines and ICD/CPT coding is typically required. Excellent analytical thinking, communication skills, and attention to detail help in collaborating with providers and ensuring appropriate care. These competencies are crucial for ensuring patients receive medically necessary care while maintaining compliance and cost-effectiveness.
What is a concurrent review?
A concurrent review is a process used in healthcare and insurance jobs where a professional evaluates a patient's case or claim while treatment or services are ongoing. This review helps determine the appropriateness, necessity, and efficiency of care in real-time, often requiring knowledge of medical records and insurance policies. It is commonly performed by healthcare professionals, case managers, or claims reviewers to ensure quality and compliance.
What is an example of a concurrent review?
A concurrent review is a process used by healthcare professionals, including those in roles like Concurrent Review, to evaluate a patient's treatment and progress while they are still receiving care. For example, reviewing a patient's hospital stay daily to determine if continued hospitalization is necessary or if care can be transitioned to outpatient services. This process helps ensure appropriate utilization of resources and timely care adjustments.
What is concurrent review in healthcare?
Concurrent review is a process used in healthcare to assess the necessity and appropriateness of ongoing inpatient care while the patient is still hospitalized. The goal is to ensure that medical services are being delivered efficiently and according to established guidelines. Utilization review nurses or case managers typically conduct these reviews by evaluating medical records, communicating with providers, and making recommendations regarding continued stay or discharge planning. This helps control healthcare costs and improves patient outcomes by preventing unnecessary treatments or extended hospitalizations.
How to make an extra 2000 a month as a nurse?
Concurrent Review nurses can increase their income by taking on overtime shifts, working in high-demand specialties, or pursuing certifications that qualify them for higher-paying roles. Additionally, some may supplement income through per diem work, telehealth services, or consulting opportunities within their field.
What is the difference between Concurrent Review vs Utilization Review?
| Aspect | Concurrent Review | Utilization Review |
|---|---|---|
| Purpose | Assess ongoing patient care during hospitalization | Evaluate the necessity and appropriateness of services, often before or after care |
| Timing | Performed in real-time during treatment | Can be pre-authorization, concurrent, or retrospective |
| Work Environment | Hospitals, clinics, insurance companies | Insurance companies, healthcare organizations |
| Credentials | Registered nurses, case managers, healthcare professionals | Medical reviewers, nurses, case managers |
Concurrent Review focuses on evaluating ongoing patient care during hospitalization, ensuring treatments are appropriate in real-time. Utilization Review has a broader scope, including pre-authorization and retrospective assessments to determine the necessity of services. While both roles involve healthcare professionals and are used within insurance and healthcare settings, their timing and specific focus differ.
What are some common challenges faced by Concurrent Review nurses, and how can they be managed?
Concurrent Review nurses often face challenges such as managing a high volume of case reviews within tight deadlines and ensuring timely communication with providers and insurance companies. Staying organized, utilizing efficient documentation systems, and maintaining up-to-date knowledge of regulatory requirements can help overcome these hurdles. Collaboration with interdisciplinary teams and regular training on evolving guidelines are also essential for success in this role.
How to make 300,000 as a nurse?
To earn $300,000 as a nurse, professionals typically work in high-paying specialties such as nurse anesthetist, nurse practitioner, or clinical nurse specialist, often requiring advanced certifications and a master's or doctoral degree. Gaining experience, working overtime, and seeking employment in high-demand settings or geographic areas with higher pay can also increase earnings.
More about Concurrent Review jobs
What states have the most Concurrent Review jobs? States with the most job openings for Concurrent Review jobs include:
What job categories do people searching Concurrent Review jobs look for? The top searched job categories for Concurrent Review jobs are:
- International Utilization Review Rn
- Optum Utilization Review Nurse
- Utilization Review Nurse Lvn
- Utilization Review No Experience
- Full Time Anthem Utilization Review Nurse
- Remote Hca Utilization Review
- Registered Nurse Case Review
- Temporary Aetna Utilization Review Nurse
- Anthem Utilization Review Nurse
- Utilization Management Review Nurse
Other
Retirement
Posted 4 days ago
BayCare Health System rating
7.5
Based on 399 frontline employees who took The Breakroom Quiz
231st of 888 rated healthcare providers
Job description
At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that's built on a foundation of trust, dignity, respect, responsibility and clinical excellence.
The Utilization Review Specialist Senior responsibilities include:
Position details:
Certifications and Licensures:
Education:
Experience:
Benefits:
Equal Opportunity Employer Veterans/Disabled
The Utilization Review Specialist Senior responsibilities include:
- Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services
- Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials.
- Preferred experience includes Critical Care or Emergency Nursing RN.
Position details:
- Location: Hybrid - St Josephs Hospital/Tampa, FL
- Status: PRN, As Needed
- Schedule: Days vary
- Weekend Requirement: Strongly prefer availability for every other weekend
- On Call: No
Certifications and Licensures:
- Required RN (Registered Nurse)
- Preferred ACM (Case Management)
- Preferred CCM (Case Manager)
Education:
- Required Associates in Nursing or
- Required Bachelors in Nursing
- Preferred Masters in Nursing or Business
Experience:
- Required 2 years in Utilization Review or
- Required 2 years in Case Management or
- Required 3 years Registered Nurse
- Preferred experience in Critical Care or Emergency Service
Benefits:
- Tuition reimbursement
- 401k match and additional yearly contribution
- Community discounts and more
Equal Opportunity Employer Veterans/Disabled
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About Baycare Health System
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Pinellas Park, FL, US
Year founded
1997