Huntsville, AL · On-site
$113K - $134K/yr
Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...
New
Huntsville, AL · On-site
$113K - $134K/yr
Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...
New
Center Point, AL · On-site
$109K - $130K/yr
Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...
New
Center Point, AL · On-site
$109K - $130K/yr
Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...
New
Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...
Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...
$55.29 - $57.69/hr
This leadership opportunity offers the chance to work alongside executive leadership while overseeing utilization review, discharge planning, and interdisciplinary care management initiatives within ...
$55.29 - $57.69/hr
This leadership opportunity offers the chance to work alongside executive leadership while overseeing utilization review, discharge planning, and interdisciplinary care management initiatives within ...
ENVIRONMENT The Health Managed Department is responsible for developing, implementing and administering private business and government utilization review, medical review, cost containment ...
ENVIRONMENT The Health Managed Department is responsible for developing, implementing and administering private business and government utilization review, medical review, cost containment ...
Birmingham, AL · On-site
ENVIRONMENT The Health Managed Department is responsible for developing, implementing and administering private business and government utilization review, medical review, cost containment ...
Birmingham, AL · On-site
ENVIRONMENT The Health Managed Department is responsible for developing, implementing and administering private business and government utilization review, medical review, cost containment ...
Montgomery, AL · On-site
$16.25 - $24.73/hr
The Consumer Benefits Specialist is responsible for coordinating consumer benefits management, representative payee oversight, utilization review activities, authorization management, and ...
Quick apply
Montgomery, AL · On-site
$16.25 - $24.73/hr
The Consumer Benefits Specialist is responsible for coordinating consumer benefits management, representative payee oversight, utilization review activities, authorization management, and ...
American Traveler is seeking an experienced RN Case Manager for an acute care hospital assignment requiring a CA RN license and 2+ years of acute care case management/discharge planning experience.
American Traveler is seeking an experienced RN Case Manager for an acute care hospital assignment requiring a CA RN license and 2+ years of acute care case management/discharge planning experience.
American Traveler is hiring an experienced RN Case Manager for an acute care hospital position requiring 2 years of acute medical Care Management/Discharge Planning experience and a CA RN license.
American Traveler is hiring an experienced RN Case Manager for an acute care hospital position requiring 2 years of acute medical Care Management/Discharge Planning experience and a CA RN license.
American Traveler is hiring an experienced RN Case Manager for a 13-week acute hospital assignment requiring 2 years of hospital case management experience and a CA RN license. Job Details • Acute ...
New
American Traveler is hiring an experienced RN Case Manager for a 13-week acute hospital assignment requiring 2 years of hospital case management experience and a CA RN license. Job Details • Acute ...
New
American Traveler is seeking an experienced RN Case Manager for a critical need position at a hospital in Woodland Hills, CA, requiring an active CA RN license and Epic EMR experience. Job Details ...
American Traveler is seeking an experienced RN Case Manager for a critical need position at a hospital in Woodland Hills, CA, requiring an active CA RN license and Epic EMR experience. Job Details ...
American Traveler is hiring a Travel RN Case Manager for a hospital-based Case Management department requiring acute care case management experience and a FL or compact RN license. Job Details • ...
American Traveler is hiring a Travel RN Case Manager for a hospital-based Case Management department requiring acute care case management experience and a FL or compact RN license. Job Details • ...
Phenix City, AL · On-site
Shift: 8:00AM - 5:00PM ET Position Goal The Case Manager is responsible for performing care coordination, utilization review support, and discharge planning. This includes assessment, identification ...
Phenix City, AL · On-site
Shift: 8:00AM - 5:00PM ET Position Goal The Case Manager is responsible for performing care coordination, utilization review support, and discharge planning. This includes assessment, identification ...
Phenix City, AL · On-site
Shift: 8:00AM - 5:00PM ET Position Goal The Case Manager is responsible for performing care coordination, utilization review support, and discharge planning. This includes assessment, identification ...
Phenix City, AL · On-site
Shift: 8:00AM - 5:00PM ET Position Goal The Case Manager is responsible for performing care coordination, utilization review support, and discharge planning. This includes assessment, identification ...
Phenix City, AL · On-site
Shift: 8:00AM - 5:00PM ET Position Goal The Case Manager is responsible for performing care coordination, utilization review support, and discharge planning. This includes assessment, identification ...
Phenix City, AL · On-site
Shift: 8:00AM - 5:00PM ET Position Goal The Case Manager is responsible for performing care coordination, utilization review support, and discharge planning. This includes assessment, identification ...
Birmingham, AL · On-site
$18 - $24.25/hr
Participate in utilization review and quality assurance activities, as directed. Coordinate U.R. activities with the BHS physician review panel as appropriate, to include ensuring on-going and timely ...
Quick apply
Birmingham, AL · On-site
$18 - $24.25/hr
Participate in utilization review and quality assurance activities, as directed. Coordinate U.R. activities with the BHS physician review panel as appropriate, to include ensuring on-going and timely ...
Birmingham, AL · On-site
$18 - $24.25/hr
Participate in utilization review and quality assurance activities, as directed. Coordinate U.R. activities with the BHS physician review panel as appropriate, to include ensuring on-going and timely ...
Birmingham, AL · On-site
$18 - $24.25/hr
Participate in utilization review and quality assurance activities, as directed. Coordinate U.R. activities with the BHS physician review panel as appropriate, to include ensuring on-going and timely ...
Birmingham, AL · On-site
$18 - $24.25/hr
Participate in utilization review and quality assurance activities, as directed. Coordinate U.R. activities with the BHS physician review panel as appropriate, to include ensuring on-going and timely ...
Birmingham, AL · On-site
$18 - $24.25/hr
Participate in utilization review and quality assurance activities, as directed. Coordinate U.R. activities with the BHS physician review panel as appropriate, to include ensuring on-going and timely ...
Overview The Case Manager is responsible to assist in the development, planning, coordination and administration of the activities of Utilization Review and Discharge Planning. Including but not ...
Overview The Case Manager is responsible to assist in the development, planning, coordination and administration of the activities of Utilization Review and Discharge Planning. Including but not ...
Utilization Review: monitor the use of hospital resources and services to ensure appropriate care and avoid unnecessary treatments or extended stays * Patient and Family Education: help patients and ...
Utilization Review: monitor the use of hospital resources and services to ensure appropriate care and avoid unnecessary treatments or extended stays * Patient and Family Education: help patients and ...
$19.39 - $23.31
2% of jobs
$23.31 - $27.24
9% of jobs
$29.92 is the 25th percentile. Wages below this are outliers.
$27.24 - $31.16
21% of jobs
The median wage is $34.33 / hr.
$31.16 - $35.08
23% of jobs
$35.08 - $39
13% of jobs
$42.05 is the 75th percentile. Wages above this are outliers.
$39 - $42.92
10% of jobs
$42.92 - $46.84
8% of jobs
$46.84 - $50.77
5% of jobs
$50.77 - $54.69
5% of jobs
$54.69 - $58.61
2% of jobs
$58.61 - $62.53
2% of jobs
$19
$38
$62
A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.
A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.
To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.
$113K - $134K/yr
Other
Posted 2 days ago
New
Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule
Leverage your clinical knowledge in a fully remote Clinical Review Pharmacist role. Evaluate prescriptions and treatment plans for safety, appropriateness, and cost-effectiveness while working from home.
Key Responsibilities
