Utilization Review- RN
Troy, MI · On-site
Qualifications Must be an RN Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft ...
Troy, MI · On-site
Qualifications Must be an RN Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft ...
Troy, MI · On-site
Qualifications Must be an RN Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft ...
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
Madera, CA · On-site
The Utilization Review Nurse assesses, plans, implements and evaluates the needs of patients for ... Requires Current California Board of Nursing Registered Nurse License. * Current American Heart ...
Quick apply
Madera, CA · On-site
The Utilization Review Nurse assesses, plans, implements and evaluates the needs of patients for ... Requires Current California Board of Nursing Registered Nurse License. * Current American Heart ...
Utilization Review * Discipline: RN * Start Date: 08/03/2026 * Duration: 13 weeks * 40 hours per week * Shift: 8 hours, days * Employment Type: Travel Minimum Years of Experience: 5 (ur) Minimum ...
Utilization Review * Discipline: RN * Start Date: 08/03/2026 * Duration: 13 weeks * 40 hours per week * Shift: 8 hours, days * Employment Type: Travel Minimum Years of Experience: 5 (ur) Minimum ...
Complex, high-risk, or ambiguous cases requiring clinical judgment are referred to a RN Utilization Review for review and determination. Essential Duties and Responsibilities These duties and ...
Complex, high-risk, or ambiguous cases requiring clinical judgment are referred to a RN Utilization Review for review and determination. Essential Duties and Responsibilities These duties and ...
Westminster, MD · On-site
$50 - $52.50/hr
Active Registered Nurse (RN) license in good standing. * Knowledge of utilization review, medical necessity criteria, reimbursement processes, and payer regulations. * Strong clinical assessment and ...
Westminster, MD · On-site
$50 - $52.50/hr
Active Registered Nurse (RN) license in good standing. * Knowledge of utilization review, medical necessity criteria, reimbursement processes, and payer regulations. * Strong clinical assessment and ...
North Carolina License as a Registered Nurse. Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of ...
North Carolina License as a Registered Nurse. Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of ...
$72K - $83K/yr
The Utilization Review Nurse assists the utilization review process taking on various tasks ... Current NYS RN licensure, BSN preferred. * Five or more years of home health care or long term care ...
$72K - $83K/yr
The Utilization Review Nurse assists the utilization review process taking on various tasks ... Current NYS RN licensure, BSN preferred. * Five or more years of home health care or long term care ...
Active Registered Nurse (RN) license in good standing. * Knowledge of utilization review, medical necessity criteria, reimbursement processes, and payer regulations. * Strong clinical assessment and ...
Active Registered Nurse (RN) license in good standing. * Knowledge of utilization review, medical necessity criteria, reimbursement processes, and payer regulations. * Strong clinical assessment and ...
The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is ...
The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is ...
Syracuse, NY · On-site
$72K - $83K/yr
The Utilization Review Nurse assists the utilization review process taking on various tasks ... Current NYS RN licensure, BSN preferred. * Five or more years of home health care or long term care ...
Syracuse, NY · On-site
$72K - $83K/yr
The Utilization Review Nurse assists the utilization review process taking on various tasks ... Current NYS RN licensure, BSN preferred. * Five or more years of home health care or long term care ...
New Orleans, LA · On-site
The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is ...
New Orleans, LA · On-site
The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is ...
The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to ...
The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to ...
Orlando, FL · On-site
$90K - $98K/yr
Current, unrestricted RN license (State license required). * Minimum 3 years of clinical nursing experience. * Minimum 1 year of Utilization Management (UM) or Utilization Review (UR) experience.
Quick apply
Orlando, FL · On-site
$90K - $98K/yr
Current, unrestricted RN license (State license required). * Minimum 3 years of clinical nursing experience. * Minimum 1 year of Utilization Management (UM) or Utilization Review (UR) experience.
And more Description The Clinical Utilization Review Nurse Preceptor (UR RN Preceptor) will be responsible for training, mentoring, and coaching for the Utilization Review Department. The UR RN ...
And more Description The Clinical Utilization Review Nurse Preceptor (UR RN Preceptor) will be responsible for training, mentoring, and coaching for the Utilization Review Department. The UR RN ...
Dallas, TX · On-site
$90K - $98K/yr
Current, unrestricted RN license (State license required). * Minimum 3 years of clinical nursing experience. * Minimum 1 year of Utilization Management (UM) or Utilization Review (UR) experience.
Quick apply
Dallas, TX · On-site
$90K - $98K/yr
Current, unrestricted RN license (State license required). * Minimum 3 years of clinical nursing experience. * Minimum 1 year of Utilization Management (UM) or Utilization Review (UR) experience.
Marion, NC · On-site
$500/wk
Utilization Review * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 40 hours per week * Shift: 8 hours * Employment Type: Travel The right role can make all the difference in your career.
Marion, NC · On-site
$500/wk
Utilization Review * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 40 hours per week * Shift: 8 hours * Employment Type: Travel The right role can make all the difference in your career.
And more Description The Clinical Utilization Review Nurse Preceptor (UR RN Preceptor) will be responsible for training, mentoring, and coaching for the Utilization Review Department. The UR RN ...
And more Description The Clinical Utilization Review Nurse Preceptor (UR RN Preceptor) will be responsible for training, mentoring, and coaching for the Utilization Review Department. The UR RN ...
Valid license by the State of Nevada to practice as a Registered Nurse. Additional Position ... Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies ...
Quick apply
Valid license by the State of Nevada to practice as a Registered Nurse. Additional Position ... Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies ...
Roseburg, OR · Remote
$85K - $105K/yr
UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state * Graduation from an ...
Quick apply
Roseburg, OR · Remote
$85K - $105K/yr
UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state * Graduation from an ...
$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
| Aspect | Executive Rn Utilization Review Nurse | Clinical Nurse Reviewer |
|---|---|---|
| Credentials | Registered Nurse (RN), often with certifications in utilization review or case management | Registered Nurse (RN), with clinical experience and sometimes certifications in case management |
| Work Environment | Insurance companies, healthcare management firms, or utilization review organizations | Hospitals, clinics, or healthcare facilities conducting clinical assessments |
| Primary Focus | Overseeing utilization review processes, policy compliance, and administrative tasks | Performing clinical reviews, assessing patient care needs, and making clinical judgments |
The Executive Rn Utilization Review Nurse primarily manages utilization review operations and policy compliance, often in administrative settings. In contrast, the Clinical Nurse Reviewer focuses on direct clinical assessments and patient care evaluations. Both roles require RN credentials and clinical knowledge, but their work environments and responsibilities differ significantly.
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines
Provider appeals and Utilization reviews and assist with Denial Letters
Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.
Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.
Must be an RN
Utilization Review background in either Managed Care of Provider environment (at least one year)
Interqual experience
Other basic computer skills necessary: Microsoft Office, Data Entry, etc.
Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.
Also has a background in patient, skilled nurses facilities, rehab, and home healthcare.
Are you an experienced RN looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career In Nursing by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the RN position for you!
If you are interested, reach out to me (Krishna) at 321-574-6926
The greatest compliment to our business is a referral.If you know of someone looking for a new opportunity, please pass along my contact information!
Sourced by ZipRecruiter
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Recruiting and staffing services
201 - 500 Employees
Maitland, FL, US
2003