New Lenox, IL · On-site
$34.73 - $45.15/hr
Medical
Dental
Vision
Life
Retirement
PTO
Performs medical record review for severity of illness and intensity of service; liaison function ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...
New Lenox, IL · On-site
$34.73 - $45.15/hr
Medical
Dental
Vision
Life
Retirement
PTO
Performs medical record review for severity of illness and intensity of service; liaison function ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...
Chicago, IL · On-site
Improve quality products and services, by using measurement and analysis to process, evaluate and ... Do you have experience with Utilization Review? * Do you have an Active Registered Nurse License?
Chicago, IL · On-site
Improve quality products and services, by using measurement and analysis to process, evaluate and ... Do you have experience with Utilization Review? * Do you have an Active Registered Nurse License?
Sandy, UT · On-site
Medical
Dental
Vision
Life
Retirement
PTO
Pre-Service Specialist GENERAL SUMMARY OF DUTIES : The Pre-Service Specialist performs general ... For further information, please review the Know Your Rights notice from the Department of Labor.
Sandy, UT · On-site
Medical
Dental
Vision
Life
Retirement
PTO
Pre-Service Specialist GENERAL SUMMARY OF DUTIES : The Pre-Service Specialist performs general ... For further information, please review the Know Your Rights notice from the Department of Labor.
Dallas, TX · Remote
$35 - $45.94/hr
Complete medical necessity reviews and level of care reviews for requested services using clinical ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...
Quick apply
Dallas, TX · Remote
$35 - $45.94/hr
Complete medical necessity reviews and level of care reviews for requested services using clinical ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...
Miami, FL · Remote
$35 - $45.94/hr
Complete medical necessity reviews and level of care reviews for requested services using clinical ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...
Quick apply
Miami, FL · Remote
$35 - $45.94/hr
Complete medical necessity reviews and level of care reviews for requested services using clinical ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...
Oxford, NC · On-site
... services or treatment and works with departments and other providers to resolve problems ... Three years clinical nursing experience. One year utilization and review experience. Experience ...
Oxford, NC · On-site
... services or treatment and works with departments and other providers to resolve problems ... Three years clinical nursing experience. One year utilization and review experience. Experience ...
Monterey Park, CA · Remote
$34 - $47/hr
Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient ...
Monterey Park, CA · Remote
$34 - $47/hr
Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient ...
$34.73 - $45.15/hr
Medical
Dental
Vision
Life
Retirement
PTO
Performs medical record review for severity of illness and intensity of service; liaison function ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...
$34.73 - $45.15/hr
Medical
Dental
Vision
Life
Retirement
PTO
Performs medical record review for severity of illness and intensity of service; liaison function ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...
Passing score(s) on job-related pre-employment assessment(s) Preferred * At least 5 years clinical ... or present military service, or any other status protected by the laws or regulations in the ...
New
Passing score(s) on job-related pre-employment assessment(s) Preferred * At least 5 years clinical ... or present military service, or any other status protected by the laws or regulations in the ...
New
$52K - $85K/yr
Medical
Dental
Vision
Life
Retirement
PTO
Itemization Review Nurse The Itemization Review Nurse provides a summary and analysis of items by ... Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
$52K - $85K/yr
Medical
Dental
Vision
Life
Retirement
PTO
Itemization Review Nurse The Itemization Review Nurse provides a summary and analysis of items by ... Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
... review ... Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance ...
... review ... Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance ...
Roseburg, OR · On-site +1
$85K - $105K/yr
Medical
Dental
Vision
Life
Retirement
PTO
POSITION PURPOSE The Utilization Management Nurse evaluates clinical service requests to ensure ... review or case management experience in managed care * Oregon residency and license * Bilingual or ...
Roseburg, OR · On-site +1
$85K - $105K/yr
Medical
Dental
Vision
Life
Retirement
PTO
POSITION PURPOSE The Utilization Management Nurse evaluates clinical service requests to ensure ... review or case management experience in managed care * Oregon residency and license * Bilingual or ...
$25 - $29/hr
Medical
Dental
Retirement
PTO
... service claims while ensuring compliance with clinical guidelines and regulatory standards ... What You'll Actually Do * Provide first level review for all outpatient and ancillary pre ...
$25 - $29/hr
Medical
Dental
Retirement
PTO
... service claims while ensuring compliance with clinical guidelines and regulatory standards ... What You'll Actually Do * Provide first level review for all outpatient and ancillary pre ...
Tempe, AZ · Remote
$35 - $45.94/hr
Complete medical necessity reviews and level of care reviews for requested services using clinical ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...
Quick apply
Tempe, AZ · Remote
$35 - $45.94/hr
Complete medical necessity reviews and level of care reviews for requested services using clinical ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...
$25 - $29/hr
Medical
Dental
Retirement
PTO
... service claims while ensuring compliance with clinical guidelines and regulatory standards ... What You'll Actually Do * Provide first level review for all outpatient and ancillary pre ...
$25 - $29/hr
Medical
Dental
Retirement
PTO
... service claims while ensuring compliance with clinical guidelines and regulatory standards ... What You'll Actually Do * Provide first level review for all outpatient and ancillary pre ...
Monterey Park, CA · Remote
$34 - $47/hr
Description Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or ...
Quick apply
Monterey Park, CA · Remote
$34 - $47/hr
Description Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or ...
New Lenox, IL · On-site +1
$34.73 - $45.15/hr
Medical
Dental
Vision
Life
Retirement
PTO
Performs medical record review for severity of illness and intensity of service; liaison function ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...
New Lenox, IL · On-site +1
$34.73 - $45.15/hr
Medical
Dental
Vision
Life
Retirement
PTO
Performs medical record review for severity of illness and intensity of service; liaison function ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...
Center, TX · On-site
$78K/yr
Experience participating in review activities associated with Health Services guidelines, Joint ... nursing, pre-and post-operative care. If applicable, credit will be given for paid and unpaid ...
Center, TX · On-site
$78K/yr
Experience participating in review activities associated with Health Services guidelines, Joint ... nursing, pre-and post-operative care. If applicable, credit will be given for paid and unpaid ...
$29 - $52/hr
Retirement
Participate in secondary reviews for HCBS services and Medicaid services * Review and process prior ... Pre-authorization experience * Utilization Management experience * Case Management experience
$29 - $52/hr
Retirement
Participate in secondary reviews for HCBS services and Medicaid services * Review and process prior ... Pre-authorization experience * Utilization Management experience * Case Management experience
Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical ... Performs verbal/fax clinical review with payer as determined by nursing judgment and/or ...
Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical ... Performs verbal/fax clinical review with payer as determined by nursing judgment and/or ...
$28.37 - $29.68
12% of jobs
$29.68 - $30.99
4% of jobs
$30.99 - $32.30
3% of jobs
$32.30 - $33.61
3% of jobs
$33.81 is the 25th percentile. Wages below this are outliers.
$33.61 - $34.92
16% of jobs
$34.92 - $36.23
6% of jobs
The median wage is $37.22 / hr.
$36.23 - $37.54
6% of jobs
$37.54 - $38.85
10% of jobs
$38.85 - $40.17
1% of jobs
$40.94 is the 75th percentile. Wages above this are outliers.
$40.17 - $41.48
22% of jobs
$41.48 - $42.79
16% of jobs
$28
$37
$42
To excel as a Pre Service Review Nurse, you need a current RN license, strong clinical judgment, expertise in medical necessity review, and deep knowledge of medical terminology and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and standardized coding systems like ICD-10 and CPT is commonly required. Exceptional attention to detail, strong organizational skills, and effective communication help a nurse stand out in this role. These capabilities are crucial for accurately assessing pre-service requests, ensuring compliance, and fostering collaboration between providers and payers.
A Pre Service Review Nurse is responsible for evaluating medical service requests before they are provided to ensure they meet insurance coverage criteria and medical necessity guidelines. They review clinical documentation, apply healthcare policies, and collaborate with physicians and healthcare teams to determine approval or denial. This role helps ensure that patients receive appropriate, cost-effective care while adhering to regulatory and organizational requirements. Strong communication, critical thinking, and knowledge of medical guidelines are essential for success in this position.
As a Pre Service Review Nurse, your day usually involves reviewing healthcare service requests for medical necessity and appropriateness based on clinical guidelines and insurance policies. You will communicate with physicians, healthcare providers, and insurance representatives to gather necessary information or clarify documentation. The role may also require documenting findings in electronic health record systems, processing authorization requests, and participating in team meetings to discuss complex cases. You’ll need to balance efficiency and accuracy while supporting timely patient care decisions and ensuring regulatory compliance.
$34.73 - $45.15/hr
Part-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 4 days ago
6.9
Based on 51 frontline employees who took The Breakroom Quiz
553rd of 1,058 rated hospitals
Get the full story on Breakroom
Sourced by ZipRecruiter
At Silver Cross, we pride ourselves on delivering unrivaled care to every patient, every time. As a result, our focus on safety, quality and patient experience has earned us numerous national awards over the years. As the needs of our community have grown, so has Silver Cross—in both size and stature. Our many healthcare services rapidly expanded, evolved and increased in complexity. To serve you and your loved ones even better than before, we've proudly partnered with many of Chicago's leading academic medical centers, bringing extraordinarily advanced care close to home.
Health care and social assistance
1,001 - 5,000 Employees
New Lenox, IL, US
1895
