Saint Louis, MO · On-site +1
$75K - $135K/yr
Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...
Saint Louis, MO · On-site +1
$75K - $135K/yr
Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...
Kansas City, MO · On-site +1
$75K - $135K/yr
Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...
Kansas City, MO · On-site +1
$75K - $135K/yr
Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...
Columbia, MO · On-site +1
$75K - $135K/yr
Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...
Columbia, MO · On-site +1
$75K - $135K/yr
Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...
Florissant, MO · On-site +1
$75K - $135K/yr
Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...
Florissant, MO · On-site +1
$75K - $135K/yr
Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...
Participate in utilization review (UR) processes, ensuring that patient care meets medical necessity criteria and level-of-care standards. * Coordinate with insurance providers and treatment team ...
New
Quick apply
Participate in utilization review (UR) processes, ensuring that patient care meets medical necessity criteria and level-of-care standards. * Coordinate with insurance providers and treatment team ...
New
This role will collaborate with the medical providers, Utilization Review Department, and Accounts Receivable Department to ensure all legal requirements regarding coding procedures and practices are ...
New
This role will collaborate with the medical providers, Utilization Review Department, and Accounts Receivable Department to ensure all legal requirements regarding coding procedures and practices are ...
New
Responsible for the performance of Utilization Review services, including pre-admission certification, second surgical opinion, concurrent utilization review, DRG validation, as well as assessment ...
Responsible for the performance of Utilization Review services, including pre-admission certification, second surgical opinion, concurrent utilization review, DRG validation, as well as assessment ...
Responsible for the performance of Utilization Review services, including pre-admission certification, second surgical opinion, concurrent utilization review, DRG validation, as well as assessment ...
Responsible for the performance of Utilization Review services, including pre-admission certification, second surgical opinion, concurrent utilization review, DRG validation, as well as assessment ...
Responsible for the performance of Utilization Review services, including pre-admission certification, second surgical opinion, concurrent utilization review, DRG validation, as well as assessment ...
Responsible for the performance of Utilization Review services, including pre-admission certification, second surgical opinion, concurrent utilization review, DRG validation, as well as assessment ...
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
New
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
New
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
New
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
New
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
New
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
New
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
New
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
New
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
New
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
New
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
New
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
New
Saint Louis, MO · On-site
$180 - $190/hr
This role combines direct psychiatric practice with medical staff supervision, clinical policy development, quality and utilization review, restraint and seclusion oversight, and committee leadership ...
Saint Louis, MO · On-site
$180 - $190/hr
This role combines direct psychiatric practice with medical staff supervision, clinical policy development, quality and utilization review, restraint and seclusion oversight, and committee leadership ...
Saint Louis, MO · On-site
$180 - $190/hr
This role combines direct psychiatric practice with medical staff supervision, clinical policy development, quality and utilization review, restraint and seclusion oversight, and committee leadership ...
Quick apply
Saint Louis, MO · On-site
$180 - $190/hr
This role combines direct psychiatric practice with medical staff supervision, clinical policy development, quality and utilization review, restraint and seclusion oversight, and committee leadership ...
Jefferson City, MO · On-site
$90 - $95/hr
... Skills and Utilization Review experience, desired. Candidate must have excellent written and verbal communication skills. Deliver excellent customer service through effective diagnosis and ...
Jefferson City, MO · On-site
$90 - $95/hr
... Skills and Utilization Review experience, desired. Candidate must have excellent written and verbal communication skills. Deliver excellent customer service through effective diagnosis and ...
Sikeston, MO · On-site
FUNCTIONS OF POSITION: 1. Performs admission, concurrent and focused reviews using severity of illness/intensity of service criteria to ensure effective utilization management. 2. Refers unjustified ...
Quick apply
Sikeston, MO · On-site
FUNCTIONS OF POSITION: 1. Performs admission, concurrent and focused reviews using severity of illness/intensity of service criteria to ensure effective utilization management. 2. Refers unjustified ...
Jefferson City, MO · On-site
$90 - $95/hr
Computer Skills and Utilization Review experience, desired. * Candidate must have excellent written and verbal communication skills. ͏ * Deliver excellent customer service through effective ...
New
Jefferson City, MO · On-site
$90 - $95/hr
Computer Skills and Utilization Review experience, desired. * Candidate must have excellent written and verbal communication skills. ͏ * Deliver excellent customer service through effective ...
New
$20.07 - $24.13
2% of jobs
$24.13 - $28.19
9% of jobs
$30.96 is the 25th percentile. Wages below this are outliers.
$28.19 - $32.24
21% of jobs
The median wage is $35.53 / hr.
$32.24 - $36.30
23% of jobs
$36.30 - $40.36
13% of jobs
$43.52 is the 75th percentile. Wages above this are outliers.
$40.36 - $44.42
10% of jobs
$44.42 - $48.48
8% of jobs
$48.48 - $52.54
5% of jobs
$52.54 - $56.60
5% of jobs
$56.60 - $60.65
2% of jobs
$60.65 - $64.71
2% of jobs
$20
$39
$64
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.
$75K - $135K/yr
Full-time
Medical, Retirement, PTO
Posted 18 days ago
8.4
Based on 401 frontline employees who took The Breakroom Quiz
24th of 887 rated healthcare providers
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.
Knowledge of utilization management principles preferred.
License/Certification:
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
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Health care and social assistance
10,000+ Employees
Saint Louis, MO, US
1984
