Minneapolis, MN · On-site
$2.9K - $3.0K/wk
Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Minneapolis ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...
Minneapolis, MN · On-site
$2.9K - $3.0K/wk
Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Minneapolis ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...
Eden Prairie, MN · On-site
... Utilization Review (DUR) 3. Knowledge on business & plan configuration and plan option knowledge. 4. Facilitate discussion with Product Owners, Business and clarify business requirements 5. High ...
Eden Prairie, MN · On-site
... Utilization Review (DUR) 3. Knowledge on business & plan configuration and plan option knowledge. 4. Facilitate discussion with Product Owners, Business and clarify business requirements 5. High ...
The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized ... Comprehensive health, dental, and life insurance packages * 401K with discretionary matching
The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized ... Comprehensive health, dental, and life insurance packages * 401K with discretionary matching
The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized ... Comprehensive health, dental, and life insurance packages * 401K with discretionary matching
The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized ... Comprehensive health, dental, and life insurance packages * 401K with discretionary matching
... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized ... Comprehensive health, dental, and life insurance packages * 401K with discretionary matching
The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized ... Comprehensive health, dental, and life insurance packages * 401K with discretionary matching
Minneapolis, MN · On-site
$68K - $70K/yr
Experience with medical record review or utilization review. Remote Work Requirements * Wired ... Health insurance, dental insurance, and telehealth services start DAY 1 * Professional and ...
Minneapolis, MN · On-site
$68K - $70K/yr
Experience with medical record review or utilization review. Remote Work Requirements * Wired ... Health insurance, dental insurance, and telehealth services start DAY 1 * Professional and ...
Marshall, MN · On-site
$10K/mo
Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time ...
Marshall, MN · On-site
$10K/mo
Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time ...
Minneapolis, MN · On-site
$2.9K - $3.0K/wk
Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...
Minneapolis, MN · On-site
$2.9K - $3.0K/wk
Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...
Minneapolis, MN · On-site
$90K - $120K/yr
... management, utilization review, or risk management * 3+ years of experience in a stop-loss, reinsurance, health insurance, or managed care environment preferred * Strong knowledge of medical ...
Minneapolis, MN · On-site
$90K - $120K/yr
... management, utilization review, or risk management * 3+ years of experience in a stop-loss, reinsurance, health insurance, or managed care environment preferred * Strong knowledge of medical ...
Plymouth, MN · Remote
$28.94 - $51.83/hr
A background in utilization review for an insurance company or experience in case management * Familiarity with InterQual and/or MCG Care Guidelines * Critical thinking skills *All Telecommuters will ...
Plymouth, MN · Remote
$28.94 - $51.83/hr
A background in utilization review for an insurance company or experience in case management * Familiarity with InterQual and/or MCG Care Guidelines * Critical thinking skills *All Telecommuters will ...
... insurance authorizations, and proactively communicating clinical and coverage-related challenges ... Oversees and contributes to clinical utilization review processes, including medical necessity ...
... insurance authorizations, and proactively communicating clinical and coverage-related challenges ... Oversees and contributes to clinical utilization review processes, including medical necessity ...
Saint Paul, MN · On-site
$42 - $48.80/hr
... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...
Saint Paul, MN · On-site
$42 - $48.80/hr
... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...
... insurance authorizations, and proactively communicating clinical and coverage-related challenges ... Oversees and contributes to clinical utilization review processes, including medical necessity ...
... insurance authorizations, and proactively communicating clinical and coverage-related challenges ... Oversees and contributes to clinical utilization review processes, including medical necessity ...
... insurance authorizations, and proactively communicating clinical and coverage-related challenges ... Oversees and contributes to clinical utilization review processes, including medical necessity ...
Quick apply
... insurance authorizations, and proactively communicating clinical and coverage-related challenges ... Oversees and contributes to clinical utilization review processes, including medical necessity ...
... insurance authorizations, and proactively communicating clinical and coverage-related challenges ... Oversees and contributes to clinical utilization review processes, including medical necessity ...
... insurance authorizations, and proactively communicating clinical and coverage-related challenges ... Oversees and contributes to clinical utilization review processes, including medical necessity ...
... insurance authorizations, and proactively communicating clinical and coverage-related challenges ... Oversees and contributes to clinical utilization review processes, including medical necessity ...
Quick apply
... insurance authorizations, and proactively communicating clinical and coverage-related challenges ... Oversees and contributes to clinical utilization review processes, including medical necessity ...
Plymouth, MN · On-site
$28.94 - $51.83/hr
A background in utilization review for an insurance company or experience in case management * Familiarity with InterQual and/or MCG Care Guidelines * Critical thinking skills *All Telecommuters will ...
Plymouth, MN · On-site
$28.94 - $51.83/hr
A background in utilization review for an insurance company or experience in case management * Familiarity with InterQual and/or MCG Care Guidelines * Critical thinking skills *All Telecommuters will ...
... insurance authorizations, and proactively communicating clinical and coverage-related challenges ... Oversees and contributes to clinical utilization review processes, including medical necessity ...
... insurance authorizations, and proactively communicating clinical and coverage-related challenges ... Oversees and contributes to clinical utilization review processes, including medical necessity ...
$20.95 - $25.19
2% of jobs
$25.19 - $29.43
9% of jobs
$32.33 is the 25th percentile. Wages below this are outliers.
$29.43 - $33.67
21% of jobs
The median wage is $37.10 / hr.
$33.67 - $37.91
23% of jobs
$37.91 - $42.14
13% of jobs
$45.44 is the 75th percentile. Wages above this are outliers.
$42.14 - $46.38
10% of jobs
$46.38 - $50.62
8% of jobs
$50.62 - $54.86
5% of jobs
$54.86 - $59.09
5% of jobs
$59.09 - $63.33
2% of jobs
$63.33 - $67.57
2% of jobs
$20
$41
$67
One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.
To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.
An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.
$2.9K - $3.0K/wk
Other
Medical, Dental, Vision
Posted 7 days ago
