Utilization Review Nurse
Providence, RI · On-site
... coordinates the clinical resolution with internal/external clinician support as required. · ... · MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. · MUST HAVE UM experience ...
Utilization Review Nurse
Providence, RI · On-site
... coordinates the clinical resolution with internal/external clinician support as required. · ... · MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. · MUST HAVE UM experience ...
In this role as a Case Management Coordinator, care management interventions focus on improving ... utilization on networks and benefit plans. May identify, initiate, and participate in on-site ...
New
In this role as a Case Management Coordinator, care management interventions focus on improving ... utilization on networks and benefit plans. May identify, initiate, and participate in on-site ...
New
Independently coordinates the clinical resolution with internal/external clinician support as ... Must have prior authorization utilization experience. * Managed Care/Medicare experience preferred.
Independently coordinates the clinical resolution with internal/external clinician support as ... Must have prior authorization utilization experience. * Managed Care/Medicare experience preferred.
Travel RN Case Manager - $2,706 per week
North Providence, RI · On-site
$2.7K/wk
Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...
Travel RN Case Manager - $2,706 per week
North Providence, RI · On-site
$2.7K/wk
Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...
Provides coordinated care support to facilitate and expedite discharges of observation patients ... Collaborates with utilization management to ensure communication between case management and ...
Provides coordinated care support to facilitate and expedite discharges of observation patients ... Collaborates with utilization management to ensure communication between case management and ...
Provides coordinated care support to facilitate and expedite discharges of observation patients ... Collaborates with utilization management to ensure communication between case management and ...
Provides coordinated care support to facilitate and expedite discharges of observation patients ... Collaborates with utilization management to ensure communication between case management and ...
Case Mgt Supv and Observation Patient Coord
$90K - $180K/yr
Provides coordinated care support to facilitate and expedite discharges of observation patients ... Collaborates with utilization management to ensure communication between case management and ...
Case Mgt Supv and Observation Patient Coord
$90K - $180K/yr
Provides coordinated care support to facilitate and expedite discharges of observation patients ... Collaborates with utilization management to ensure communication between case management and ...
Provides coordinated care support to facilitate and expedite discharges of observation patients ... Collaborates with utilization management to ensure communication between case management and ...
Provides coordinated care support to facilitate and expedite discharges of observation patients ... Collaborates with utilization management to ensure communication between case management and ...
The Behavioral Health Intake and Utilization Review Coordinator is responsible for bed management, reviewing intake assessments, verifying clinical appropriateness for services, coordinating ...
The Behavioral Health Intake and Utilization Review Coordinator is responsible for bed management, reviewing intake assessments, verifying clinical appropriateness for services, coordinating ...
The Behavioral Health Intake and Utilization Review Coordinator is responsible for bed management, reviewing intake assessments, verifying clinical appropriateness for services, coordinating ...
The Behavioral Health Intake and Utilization Review Coordinator is responsible for bed management, reviewing intake assessments, verifying clinical appropriateness for services, coordinating ...
The Behavioral Health Intake and Utilization Review Coordinator is responsible for bed management, reviewing intake assessments, verifying clinical appropriateness for services, coordinating ...
The Behavioral Health Intake and Utilization Review Coordinator is responsible for bed management, reviewing intake assessments, verifying clinical appropriateness for services, coordinating ...
The Behavioral Health Intake and Utilization Review Coordinator is responsible for bed management, reviewing intake assessments, verifying clinical appropriateness for services, coordinating ...
The Behavioral Health Intake and Utilization Review Coordinator is responsible for bed management, reviewing intake assessments, verifying clinical appropriateness for services, coordinating ...
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs ... Fosters patient flow and throughput by coordinating patients' transition through the hospital via ...
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs ... Fosters patient flow and throughput by coordinating patients' transition through the hospital via ...
RN Care Manager
Warwick, RI · On-site
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs ... Fosters patient flow and throughput by coordinating patients' transition through the hospital via ...
RN Care Manager
Warwick, RI · On-site
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs ... Fosters patient flow and throughput by coordinating patients' transition through the hospital via ...
RN Care Manager
Warwick, RI · On-site
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs ... Fosters patient flow and throughput by coordinating patients' transition through the hospital via ...
RN Care Manager
Warwick, RI · On-site
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs ... Fosters patient flow and throughput by coordinating patients' transition through the hospital via ...
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs ... Fosters patient flow and throughput by coordinating patients' transition through the hospital via ...
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs ... Fosters patient flow and throughput by coordinating patients' transition through the hospital via ...
Provides coordinated care support to the Surgical Services, Total Joint Center, Case Management ... served and in utilization management. Demonstrated knowledge and skills necessary to provide ...
Provides coordinated care support to the Surgical Services, Total Joint Center, Case Management ... served and in utilization management. Demonstrated knowledge and skills necessary to provide ...
Provides coordinated care support to the Surgical Services, Total Joint Center, Case Management ... served and in utilization management. Demonstrated knowledge and skills necessary to provide ...
Provides coordinated care support to the Surgical Services, Total Joint Center, Case Management ... served and in utilization management. Demonstrated knowledge and skills necessary to provide ...
Provides coordinated care support to the Surgical Services, Total Joint Center, Case Management ... served and in utilization management. Demonstrated knowledge and skills necessary to provide ...
Provides coordinated care support to the Surgical Services, Total Joint Center, Case Management ... served and in utilization management. Demonstrated knowledge and skills necessary to provide ...
Case Management Special Programs - Per Diem Case Manager
Providence, RI · On-site
$38.62 - $77.22/hr
Provides coordinated care support to the Surgical Services, Total Joint Center, Case Management ... served and in utilization management. Demonstrated knowledge and skills necessary to provide ...
Case Management Special Programs - Per Diem Case Manager
Providence, RI · On-site
$38.62 - $77.22/hr
Provides coordinated care support to the Surgical Services, Total Joint Center, Case Management ... served and in utilization management. Demonstrated knowledge and skills necessary to provide ...
Utilization Management Coordinator information
See Rhode Island salary details
$15.54 - $18.28
7% of jobs
$20.79 is the 25th percentile. Wages below this are outliers.
$18.28 - $21.02
19% of jobs
$21.02 - $23.76
22% of jobs
The median wage is $24.03 / hr.
$23.76 - $26.49
11% of jobs
$26.49 - $29.23
4% of jobs
$29.23 - $31.97
5% of jobs
$33.13 is the 75th percentile. Wages above this are outliers.
$31.97 - $34.71
14% of jobs
$34.71 - $37.45
10% of jobs
$37.45 - $40.19
4% of jobs
$40.19 - $42.93
2% of jobs
$42.93 - $45.67
1% of jobs
$15
$28
$45
How much do utilization management coordinator jobs pay per hour?
As of Aug 30, 2026, the average hourly pay for utilization management coordinator in Rhode Island is $29.00, according to ZipRecruiter salary data. Most workers in this role earn between $20.96 and $33.89 per hour, depending on experience, location, and employer.
What does a utilization management coordinator do?
A Utilization Management Coordinator is responsible for reviewing and assessing healthcare services to ensure that patients receive appropriate care while managing costs for healthcare providers or insurance companies. They evaluate medical records, coordinate with healthcare professionals, and help determine if certain treatments or procedures are medically necessary according to established guidelines. Their goal is to optimize the use of healthcare resources, prevent unnecessary treatments, and support quality patient outcomes.
What are the key skills and qualifications needed to thrive as a utilization management coordinator?
To thrive as a Utilization Management Coordinator, you need a background in healthcare or nursing, knowledge of medical terminology, and experience in case management or utilization review, often supported by a relevant degree or certification (such as RN or LPN). Familiarity with utilization management software, electronic health records (EHRs), and insurance authorization platforms is typically required. Strong organizational skills, attention to detail, and effective communication are essential soft skills for this role. These capabilities ensure accurate review of medical cases, compliance with regulations, and efficient coordination between providers, payers, and patients.
How does a utilization management coordinator typically collaborate with clinical staff and insurance providers?
A Utilization Management Coordinator serves as a vital link between healthcare providers, clinical staff, and insurance companies. They regularly communicate with physicians and nurses to gather clinical information, review treatment plans, and ensure that proposed services meet medical necessity criteria. Coordinators also interact with insurance providers to obtain pre-authorizations, clarify coverage policies, and appeal denied claims when appropriate. Effective collaboration and strong communication skills are essential, as the role requires balancing the needs of patients, providers, and payers while ensuring timely and cost-effective care.
What degree do you need for utilization management coordinator?
A utilization management coordinator typically needs at least a bachelor's degree in healthcare administration, nursing, or a related field. Relevant certifications, such as Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Strong knowledge of medical terminology, insurance processes, and data analysis tools is also important.
What are popular job titles related to Utilization Management Coordinator jobs in Rhode Island?
For Utilization Management Coordinator jobs in Rhode Island, the most frequently searched job titles are:
What job categories do people searching Utilization Management Coordinator jobs in Rhode Island look for?
The top searched job categories for Utilization Management Coordinator jobs in Rhode Island are:
- Utilization Review Coordinator
- Remote Dental Utilization Review
- Internship Patient Care Coordinator
- Utilization Review Clinician
- Full Time Navihealth Utilization Review
- Insurance Utilization Reviewer
- Remote Aetna Utilization Review Nurse
- Utilization Review Manager
- Coordinator Hospital Risk
- Remote Utilization Review
What cities in Rhode Island are hiring for Utilization Management Coordinator jobs?
Cities in Rhode Island with the most Utilization Management Coordinator job openings:
Utilization Review Nurse
Providence, RI • On-site
US Tech Solutions •
IT Services • 1 - 5K employees1,001 - 5,000 employees
Other
Re-posted 6 days ago
Job description
Please note: Actual location may vary., RI
Contract
Job Description:
· Participates in the development and ongoing implementation of QM Work Plan activities.
· Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives
Responsibilities:
· Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.
· Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.
· Data gathering requires navigation through multiple system applications.
· Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.
· Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.
· Responsible for the review and evaluation of clinical information and documentation.
· Reviews documentation and interprets data obtained form clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues.
· Works Potential Quality of Care cases across all lines of business (Commercial and Medicare).
· Independently coordinates the clinical resolution with internal/external clinician support as required.
· Processes and evaluates complex data and information sets -Converts the results of data analysis into meaningful business information and reaches conclusions about the data
· Prepares and completes QM documents based on interpretation and application of business requirements
· Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements
· Assists in the development and implementation of QM projects and activities
· Accountable for completing and implementation of QM Work Plan Activities
Experience:
· 3+ years of experience as an RN
· 1+ years of inpatient hospital experience
· Registered Nurse in state of residence
· Must have prior authorization utilization experience
· Able to work in multiple IT platforms/systems
Skills:
· MUST HAVE MEDCOMPASS or ASSURECARE exp.
· MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge.
· MUST HAVE UM experience, inpatient utilization management review.
· MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG.
· MUST HAVE 6 months of Prior Authorization.
Education:
· Active and unrestricted RN licensure in state of residence
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com/) .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
About US Tech Solutions
Sourced by ZipRecruiter
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.
Industry
It services
Company size
1,001 - 5,000 Employees
Headquarters location
Jersey City, NJ, US
Year founded
2000