York, ME · On-site
Must have utilization reveiw and discharge planning experience. * Certification by a nationally recognized case management or utilization review organization preferred Must have active BLS. CCM or ...
York, ME · On-site
Must have utilization reveiw and discharge planning experience. * Certification by a nationally recognized case management or utilization review organization preferred Must have active BLS. CCM or ...
Milton, NH · On-site
$65K - $70K/yr
Assisting with the discharge process while utilizing discharge tools and tracking the entire process through the EMR, while ensuring constant communication with billing and Utilization Review team ...
Milton, NH · On-site
$65K - $70K/yr
Assisting with the discharge process while utilizing discharge tools and tracking the entire process through the EMR, while ensuring constant communication with billing and Utilization Review team ...
Portsmouth, NH · On-site
Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity * Manages the process to review and, as appropriate, appeal denials received from ...
Portsmouth, NH · On-site
Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity * Manages the process to review and, as appropriate, appeal denials received from ...
Maintain accurate documentation and consistent communication with clinical, billing, and utilization review teams. Qualifications * Bachelor's degree preferred. * Minimum of 2 years of experience in ...
Maintain accurate documentation and consistent communication with clinical, billing, and utilization review teams. Qualifications * Bachelor's degree preferred. * Minimum of 2 years of experience in ...
Concord, NH · On-site
Strong knowledge of case management principles, discharge planning, and utilization review. * Excellent communication, organizational, and problem-solving skills. * BLS certification (required); ACLS ...
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Concord, NH · On-site
Strong knowledge of case management principles, discharge planning, and utilization review. * Excellent communication, organizational, and problem-solving skills. * BLS certification (required); ACLS ...
Apply Early
Concord, NH · On-site
$64 - $65/hr
Participate in interdisciplinary care planning, patient conferences, and utilization review meetings * Recommend appropriate Durable Medical Equipment (DME) to support safe mobility and discharge ...
Concord, NH · On-site
$64 - $65/hr
Participate in interdisciplinary care planning, patient conferences, and utilization review meetings * Recommend appropriate Durable Medical Equipment (DME) to support safe mobility and discharge ...
Concord, NH · On-site
$22.25 - $27.50/hr
Certification, Registration & Licensure Experience Minimum of five years' experience in utilization review and/or auditing in an acute-care hospital setting. Medicare audit and appeal background ...
Concord, NH · On-site
$22.25 - $27.50/hr
Certification, Registration & Licensure Experience Minimum of five years' experience in utilization review and/or auditing in an acute-care hospital setting. Medicare audit and appeal background ...
Concord, NH · On-site
$22.25 - $27.50/hr
Certification, Registration & Licensure Experience Minimum of five years' experience in utilization review and/or auditing in an acute-care hospital setting. Medicare audit and appeal background ...
Concord, NH · On-site
$22.25 - $27.50/hr
Certification, Registration & Licensure Experience Minimum of five years' experience in utilization review and/or auditing in an acute-care hospital setting. Medicare audit and appeal background ...
Milton, NH · On-site
$23 - $25/hr
Maintain accurate documentation and consistent communication with clinical, billing, and utilization review teams. Qualifications * Bachelor's degree preferred. * Minimum of 2 years of experience in ...
Milton, NH · On-site
$23 - $25/hr
Maintain accurate documentation and consistent communication with clinical, billing, and utilization review teams. Qualifications * Bachelor's degree preferred. * Minimum of 2 years of experience in ...
Concord, NH · On-site
$59.02 - $79.67/hr
Maintains individual and group counseling documentation to support comprehensive treatment, discharge and transition planning, and utilization review to insure accurate and timely reimbursement of ...
Concord, NH · On-site
$59.02 - $79.67/hr
Maintains individual and group counseling documentation to support comprehensive treatment, discharge and transition planning, and utilization review to insure accurate and timely reimbursement of ...
$66K - $101K/yr
A cost containment background, such as utilization review or managed care is helpful * Strong interpersonal, time management, and organizational skills * Computer proficiency and technical aptitude ...
$66K - $101K/yr
A cost containment background, such as utilization review or managed care is helpful * Strong interpersonal, time management, and organizational skills * Computer proficiency and technical aptitude ...
Brentwood, NH · On-site
$17.25 - $21.50/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Brentwood, NH · On-site
$17.25 - $21.50/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
$66K - $101K/yr
A cost containment background, such as utilization review or managed care is helpful * Strong interpersonal, time management, and organizational skills * Computer proficiency and technical aptitude ...
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$66K - $101K/yr
A cost containment background, such as utilization review or managed care is helpful * Strong interpersonal, time management, and organizational skills * Computer proficiency and technical aptitude ...
Apply Early
Concord, NH · On-site
$16.75 - $21/hr
... drug utilization review (DUR), pharmacy professional standards such as corresponding responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that ...
Concord, NH · On-site
$16.75 - $21/hr
... drug utilization review (DUR), pharmacy professional standards such as corresponding responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that ...
$17 - $21/hr
... drug utilization review (DUR), pharmacy professional standards such as corresponding responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that ...
$17 - $21/hr
... drug utilization review (DUR), pharmacy professional standards such as corresponding responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that ...
Concord, NH · On-site
$89.23 - $121.58/hr
The role of the inpatient case manager is one of patient advocate of appropriate utilization of resources. The inpatient case manager applies the process of assessment, planning, implementation ...
Concord, NH · On-site
$89.23 - $121.58/hr
The role of the inpatient case manager is one of patient advocate of appropriate utilization of resources. The inpatient case manager applies the process of assessment, planning, implementation ...
Concord, NH · On-site
$89.23 - $121.58/hr
The role of the inpatient case manager is one of patient advocate of appropriate utilization of resources. The inpatient case manager applies the process of assessment, planning, implementation ...
Concord, NH · On-site
$89.23 - $121.58/hr
The role of the inpatient case manager is one of patient advocate of appropriate utilization of resources. The inpatient case manager applies the process of assessment, planning, implementation ...
Portsmouth, NH · On-site
$108K - $141K/yr
... utilization, identifying variances and opportunities, and adjusting as needed to meet service and fiscal goals. Prepares Monthly Operating Review report. * Assures compliance with standards set forth ...
Portsmouth, NH · On-site
$108K - $141K/yr
... utilization, identifying variances and opportunities, and adjusting as needed to meet service and fiscal goals. Prepares Monthly Operating Review report. * Assures compliance with standards set forth ...
Durham, NH · On-site
$45 - $55/hr
... utilization of Physician Assistants in NH, at all times. * Diagnoses health and developmental ... Reviews and updates clinical guidelines. Minimum Qualifications * Graduate of an approved Nurse ...
Durham, NH · On-site
$45 - $55/hr
... utilization of Physician Assistants in NH, at all times. * Diagnoses health and developmental ... Reviews and updates clinical guidelines. Minimum Qualifications * Graduate of an approved Nurse ...
... review, location and geographic strategy, and productivity and utilization analysis -- then turn those findings into implementable recommendations. Outcomes include: streamlined organizations ...
... review, location and geographic strategy, and productivity and utilization analysis -- then turn those findings into implementable recommendations. Outcomes include: streamlined organizations ...
$20.94 - $25.17
2% of jobs
$25.17 - $29.41
9% of jobs
$32.31 is the 25th percentile. Wages below this are outliers.
$29.41 - $33.64
21% of jobs
The median wage is $37.07 / hr.
$33.64 - $37.88
23% of jobs
$37.88 - $42.11
13% of jobs
$45.41 is the 75th percentile. Wages above this are outliers.
$42.11 - $46.35
10% of jobs
$46.35 - $50.58
8% of jobs
$50.58 - $54.82
5% of jobs
$54.82 - $59.05
5% of jobs
$59.05 - $63.29
2% of jobs
$63.29 - $67.52
2% of jobs
$20
$41
$67
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.
LanceSoft is seeking a travel nurse RN Care Manager for a travel nursing job in York, Maine.
Job Description & RequirementsAt York Hospital, we're more than a hospital. We are a team of providers, clinicians and staff members offering expertise within a Hospital setting, our community sites, and physician practices located throughout Southern Maine and the NH seacoast. Our caregivers' commitment is to make a positive difference in the lives of one another, our patients and our community by instilling our vision of Loving Kindness for all.
We currently have an opportunity for two experienced RN Care Manager for a 13 week assignment at our main campus in York, Maine. These are 40 hour per week positions with variable shifts of either 8:30 to 4:30 or four ten (10) hour shifts that will start at 7:30 am - 5:00 pm . There is no call, but weekend and holiday rotation is required. The RN Care Manager will coordinate concurrent utilization management activities house-wide and is the main link between the patient, health care team, organization, and payors during the patient's hospital stay.
Duties and Responsibilities:
Education/Licensure/Certifications/Qualifications:
Established in 2000, LanceSoft is a Certified MBE and Woman-Owned organization. Lancesoft Inc. is one of the highest rated companies in the industry. We have been recognized as one of the Largest Staffing firms and ranked in the top 50 fastest Growing Healthcare Staffing firms in 2022. Lancesoft offers short- and long-term contracts, permanent placements, and travel opportunities to credentialed and experienced professionals throughout the United States. We pride ourselves on having industry leading benefits. We understand the importance of partnering with an expert who values your needs, which is why we’re 100% committed to finding you an assignment that best matches your career and lifestyle goals. Our team of experienced career specialists takes the time to understand your needs and match you with the right job Lancesoft has been chosen by Staffing Industry Analysts as one of the Best Staffing Firms to Work for.LanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities.
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Established in 2000, LanceSoft is a Certified MBE and Woman-Owned organization. Lancesoft Inc. is one of the highest rated companies in the industry. We have been recognized as one of the Largest Staffing firms and ranked in the top 50 fastest Growing Healthcare Staffing firms in 2022. Lancesoft offers short- and long-term contracts, permanent placements, and travel opportunities to credentialed and experienced professionals throughout the United States. We pride ourselves on having industry leading benefits. We understand the importance of partnering with an expert who values your needs, which is why we're 100% committed to finding you an assignment that best matches your career and lifestyle goals. Our team of experienced career specialists takes the time to understand your needs and match you with the right job Lancesoft has been chosen by Staffing Industry Analysts as one of the Best Staffing Firms to Work for.LanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities.
Recruiting and staffing services
1,001 - 5,000 Employees
Herndon, VA, US
2000
