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Elevance Health

Nurse Reviewer 1

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and ...

Pacer Group

HEDIS Data Reviewer

Strong attention to detail with demonstrated ability to maintain accuracy while reviewing complex or lengthy medical record documentation. * Self-motivated with the ability to take initiative ...

Curia, Inc.

Data Reviewer III

Rensselaer, NY · On-site

... reviewing electronic data * Verify for traceability of samples, standards, reagents, instruments etc. * Verify the usage logbook, calibration of instruments and shelf life of standards and reagents ...

MyFlorida

SANS REVIEWER - 67011547

Tallahassee, FL · On-site +1

$2.2K/wk

SANS REVIEWER - 67011547 Pay Plan: Career Service Position Number: 67011547 Salary: $57,281.38 to $57,281.38 Annually Posting Closing Date: 08/18/2026 Total Compensation Estimator Tool AGENCY FOR ...

Peraton

Nurse Reviewer - Medicaid

$66K - $106K/yr

Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases * Knowledge of Medicaid requirements, laws, rules and regulations related to ...

Elevance Health

Nurse Reviewer 1

Grand Prairie, TX · On-site

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and ...

Prime Time Healthcare

Utilization Review

Baltimore, MD · On-site

Now Hiring: RN Utilization Review - Baltimore, MD Are you a passionate RN professional looking for a new adventure? Prime Time Healthcare is seeking dynamic individuals like you to join our team in ...

Elevance Health

Nurse Reviewer 1

Mason, OH · On-site

Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This ...

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Can you actually get paid to review products?

Reviewing is a common job where individuals are paid to evaluate products, often through companies that seek consumer feedback. Payment can vary based on the complexity of the review, the platform, and whether the reviewer is a professional or a casual participant, with some roles requiring writing skills or familiarity with review tools.

What is the difference between Reviewing vs Quality Control Specialist?

AspectReviewingQuality Control Specialist
Required CredentialsTypically a degree in relevant field, training in review processesCertifications in quality management, technical training
Work EnvironmentOffice, editing suites, or remoteManufacturing plants, labs, or production facilities
Employer & Industry UsagePublishing, media, education, and corporate sectorsManufacturing, healthcare, engineering, and production
Common Search & Comparison IntentUnderstanding review roles, editing, or content assessmentEnsuring product quality, compliance, and standards

Reviewing involves evaluating content, documents, or media for accuracy and clarity, often in publishing or media industries. Quality Control Specialists focus on inspecting products or processes to meet quality standards, mainly in manufacturing or technical fields. While both roles aim to ensure standards, Reviewing emphasizes content accuracy, whereas Quality Control emphasizes product quality and compliance.

How do I become a reviewing?

To become a reviewer, you typically need strong communication skills, attention to detail, and knowledge of the subject area. Gaining experience through writing samples or volunteering can help, and some roles may require familiarity with review platforms or tools. Building a reputation for quality and reliability is essential for advancing in reviewing roles.

What does a reviewer do?

A reviewer is responsible for evaluating and providing feedback on various types of work, such as manuscripts, products, services, or performances. Their role involves assessing quality, accuracy, and compliance with standards or guidelines, and offering constructive recommendations for improvement. Reviewers may work in industries like publishing, academia, entertainment, or consumer goods, and their insights help maintain high standards and inform decision-making. The specifics of the job can vary depending on the field, but attention to detail and critical thinking are essential skills for reviewers.

What are some typical challenges faced by professionals in reviewing roles, and how can they be addressed?

Professionals in reviewing roles often encounter tight deadlines, the need to maintain objectivity, and the responsibility of providing constructive feedback. Balancing thoroughness with efficiency is a common challenge, as is handling a high volume of work without sacrificing quality. To address these issues, reviewers benefit from strong time-management skills, clear communication with colleagues, and standardized review guidelines to ensure consistency and accuracy. Collaboration with other reviewers or team members can also help distribute workload and offer diverse perspectives.

What are the key skills and qualifications needed to thrive as a reviewer, and why are they important?

To thrive as a Reviewer, you need strong analytical skills, subject matter expertise, and attention to detail, often supported by relevant academic or professional qualifications. Familiarity with review management systems, editorial platforms, and citation tools is typically required. Excellent written communication, objectivity, and time management are vital soft skills for delivering thorough and constructive feedback. These skills ensure high-quality, unbiased evaluations that contribute to the credibility and improvement of the work being reviewed.
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Infographic showing various Reviewing job openings in the United States as of August 2026, with employment types broken down into 75% Full Time, and 25% Contract. Highlights an 50% In-person, and 50% Remote job distribution.

RN - Utilization Review - Utilization Review

University of Mississippi Medical Center

Jackson, MS • On-site

Other

This job post has expired 6 days ago. Applications are no longer accepted.

University Of Mississippi Medical Center rating

7.4

Company rating: 7.4 out of 10

Based on 47 frontline employees who took The Breakroom Quiz

349th of 1,059 rated hospitals

Job description

Hello,
Thank you for your interest in career opportunities with the University of Mississippi Medical Center. Please review the following instructions prior to submitting your job application:

  • Provide all of your employment history, education, and licenses/certifications/registrations. You will be unable to modify your application after you have submitted it.
  • You must meet all of the job requirements at the time of submitting the application.
  • You can only apply one time to a job requisition.
  • Once you start the application process you cannot save your work. Please ensure you have all required attachment(s) available to complete your application before you begin the process.
  • Applications must be submitted prior to the close of the recruitment. Once recruitment has closed, applications will no longer be accepted.
After you apply, we will review your qualifications and contact you if your application is among the most highly qualified. Due to the large volume of applications, we are unable to individually respond to all applicants. You may check the status of your application via your Candidate Profile.
Thank you,
Human Resources
Important Applications Instructions:
Please complete this application in entirety by providing all of your work experience, education and certifications/
license. You will be unable to edit/add/change your application once it is submitted.
Job Requisition ID:
R00050784
Job Category:
Nursing
Organization:
Utilization Review
Location/s:
Main Campus Jackson
Job Title:
RN - Utilization Review - Utilization Review
Job Summary:
RN-Utilization Review is accountable to perform utilization management services for designated patient case load, including prospective, concurrent, retrospective, and denial management reviews by applying clinical protocols and review medical necessity criteria. Reports quality of care issues identified during the utilization management process to the appropriate manager.
Education & Experience
Education and Experience Required:
One (1) year of nursing experience in an inpatient setting.
Certifications, Licenses, or Registration required:
Valid RN license.
Knowledge, Skills & Abilities
Knowledge, Skills, and Abilities:
Knowledge of utilization review, discharge planning, case management, and managed care reimbursement. Strong working knowledge of medical procedures, diagnoses, and procedure codes, including ICD-10, CPT, and DSM-IV. Excellent interpersonal, verbal, written communication, and negotiation skills. Ability to gather data, prepare reports, and identify process improvements. Able to work independently, exercise sound judgment, and apply medical necessity guidelines with minimal supervision. Committed to quality patient care, customer service, safety, cost efficiency, and continuous quality improvement (CQI). Proficient in the use of computers and related software applications.
Responsibilities:
  • Performs prospective, concurrent, retrospective, and denials review for individual cases, including benefit coverage, medical necessity, appropriate level of care, and mandated services.
  • Assists in collecting and reporting financial and performance indicators, including case mix, length of stay, cost per case, resource utilization, readmission rates, denials, and appeals.
  • Uses data to drive decisions and implement performance improvement strategies related to case management, including fiscal, clinical, and patient satisfaction outcomes.
  • Collects and analyzes variances from the plan of care and collaborates with physicians and the healthcare team to address issues and improve outcomes.
  • Applies clinical appropriateness criteria to monitor admissions and continued stays, identifies at-risk populations, and refers cases to the care management physician advisor as needed.
  • Communicates with third-party payers to facilitate reimbursement certification, resolves payor issues, and completes utilization management and quality screening for assigned patients.
  • Works collaboratively with the interdisciplinary care team to ensure timely, appropriate patient management, remove barriers to care, and proactively address delays or discharge obstacles.
  • Ensures safe, high-quality care in compliance with policies, procedures, and standards, while managing time, supplies, productivity, and accuracy within budgetary guidelines.
  • The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands:
Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, no handling or working with potentially dangerous equipment, occasional working hours beyond regularly scheduled hours, occasional travelling to offsite locations, occasional activities subject to significant volume changes of a seasonal/clinical nature, occasional work produced is subject to precise measures of quantity and quality, occasional bending, occasional lifting/carrying up to 10 pounds, occasional lifting/carrying up to 25 pounds, no lifting/carrying up to 50 pounds, no lifting/carrying up to 75 pounds, no lifting/carrying up to100 pounds, no lifting/carrying 100 pounds or more, no climbing, no crawling, occasional crouching/stooping, no driving, occasional kneeling, occasional pushing/pulling, occasional reaching, frequent sitting, occasional standing ,occasional twisting, and frequent walking. (Occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)
Time Type:
Full time
FLSA Designation/Job Exempt:
Yes
Pay Class:
Salary
FTE %:
100
Work Shift:
Day
Benefits Eligibility:
Grant Funded:
No
Job Posting Date:
07/7/2026
Job Closing Date (open until filled if no date specified):

What University Of Mississippi Medical Center employees say

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University of Mississippi Medical Center logo

About University of Mississippi Medical Center

Sourced by ZipRecruiter

The University of Mississippi Medical Center (UMMC) is the state's sole academic medical center, focused on enhancing the lives of Mississippi residents through education, research, and healthcare. UMMC houses seven health science schools with over 3,000 enrolled students, and its researchers are renowned for their contributions to areas like heart disease, diabetes, hypertension, and cancer treatment. Their efforts not only improve health outcomes but also drive economic growth and job opportunities in the state.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Jackson, MS, US

Year founded

1955

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