Providence, RI · On-site
... 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 ...
Providence, RI · On-site
... 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 ...
Providence, RI · On-site
$70 - $95/hr
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
New
Providence, RI · On-site
$70 - $95/hr
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
New
Providence, RI · On-site
$85 - $110/hr
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
New
Providence, RI · On-site
$85 - $110/hr
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
New
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
Providence, RI · On-site
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
Providence, RI · On-site
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
Providence, RI · On-site
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
Providence, RI · On-site
Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager ... EMR, Microsoft Office, etc.) Participation in weekend and holiday coverage rotation. Flexibility to ...
Providence, RI · On-site
Utilization Review; Resource Management; Continuum of Care Management (Discharge planning) and Clinical Documentation Management. Collects data via utilization with Care Port to enhance the quality ...
Providence, RI · On-site
Utilization Review; Resource Management; Continuum of Care Management (Discharge planning) and Clinical Documentation Management. Collects data via utilization with Care Port to enhance the quality ...
Providence, RI · On-site
Utilization Review; Resource Management; Continuum of Care Management (Discharge planning) and Clinical Documentation Management. Collects data via utilization with Care Port to enhance the quality ...
Providence, RI · On-site
Utilization Review; Resource Management; Continuum of Care Management (Discharge planning) and Clinical Documentation Management. Collects data via utilization with Care Port to enhance the quality ...
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 ...
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 ...
Pawtucket, RI · On-site
$48K - $52K/yr
This position includes evening and weekend coverage and an ability to work collaboratively with a ... evaluation/utilization review, * Provide resources, advocacy, informal counseling, mentoring ...
Pawtucket, RI · On-site
$48K - $52K/yr
This position includes evening and weekend coverage and an ability to work collaboratively with a ... evaluation/utilization review, * Provide resources, advocacy, informal counseling, mentoring ...
Weekday availability required, Weekend availability as needed (admissions and continued ... Through the integration of case management, utilization review, and discharge planning functions ...
New
Weekday availability required, Weekend availability as needed (admissions and continued ... Through the integration of case management, utilization review, and discharge planning functions ...
New
Warwick, RI · On-site
Weekday availability required, Weekend availability as needed (admissions and continued ... Through the integration of case management, utilization review, and discharge planning functions ...
Warwick, RI · On-site
Weekday availability required, Weekend availability as needed (admissions and continued ... Through the integration of case management, utilization review, and discharge planning functions ...
Newport, RI · On-site
$34.20 - $56.42/hr
Knowledge of utilization review process, health care reimbursement, and physical rehabilitation ... Weekdays as needed for coverage, one weekend per month Work Shift: Day Daily Hours: Per Diem - As ...
Newport, RI · On-site
$34.20 - $56.42/hr
Knowledge of utilization review process, health care reimbursement, and physical rehabilitation ... Weekdays as needed for coverage, one weekend per month Work Shift: Day Daily Hours: Per Diem - As ...
Lincoln, RI · On-site
Participate on an assigned advisory board or utilization review committee. * Review all client records every 90 days or more often, if necessary. * QA record checks on 10% of clients' charts of ...
Lincoln, RI · On-site
Participate on an assigned advisory board or utilization review committee. * Review all client records every 90 days or more often, if necessary. * QA record checks on 10% of clients' charts of ...
Cumberland, RI · On-site
Participate on an assigned advisory board or utilization review committee. * Review all client records every 90 days or more often, if necessary. * QA record checks on 10% of clients' charts of ...
Cumberland, RI · On-site
Participate on an assigned advisory board or utilization review committee. * Review all client records every 90 days or more often, if necessary. * QA record checks on 10% of clients' charts of ...
Newport, RI · On-site
$34.20 - $56.42/hr
Knowledge of utilization review process, health care reimbursement, and physical rehabilitation ... weekend per month Work Shift Day Daily Hours Per Diem - As required Driving Required No Brown ...
Newport, RI · On-site
$34.20 - $56.42/hr
Knowledge of utilization review process, health care reimbursement, and physical rehabilitation ... weekend per month Work Shift Day Daily Hours Per Diem - As required Driving Required No Brown ...
This position includes evening and weekend coverage and an ability to work collaboratively with a ... evaluation/utilization review, * Provide resources, advocacy, informal counseling, mentoring ...
This position includes evening and weekend coverage and an ability to work collaboratively with a ... evaluation/utilization review, * Provide resources, advocacy, informal counseling, mentoring ...
Lincoln, RI · On-site
Participate on an assigned advisory board or utilization review committee. * Review all client records every 90 days or more often, if necessary. * QA record checks on 10% of clients' charts of ...
Lincoln, RI · On-site
Participate on an assigned advisory board or utilization review committee. * Review all client records every 90 days or more often, if necessary. * QA record checks on 10% of clients' charts of ...
$20.95 - $25.19
2% of jobs
$25.19 - $29.43
9% of jobs
$32.33 is the 25th percentile. Wages below this are outliers.
$29.43 - $33.66
21% of jobs
The median wage is $37.09 / hr.
$33.66 - $37.90
23% of jobs
$37.90 - $42.14
13% of jobs
$45.43 is the 75th percentile. Wages above this are outliers.
$42.14 - $46.38
10% of jobs
$46.38 - $50.61
8% of jobs
$50.61 - $54.85
5% of jobs
$54.85 - $59.09
5% of jobs
$59.09 - $63.33
2% of jobs
$63.33 - $67.56
2% of jobs
$20
$41
$67
A Weekend Utilization Review job involves assessing patient care and medical services during weekends to ensure they meet medical necessity and insurance guidelines. Professionals in this role review clinical documentation, coordinate with healthcare providers, and determine appropriate levels of care for patients. They typically work for hospitals, insurance companies, or other healthcare organizations. Strong analytical skills, medical knowledge, and familiarity with regulatory requirements are essential for success in this role.
Weekend Utilization Review professionals typically work independently, reviewing patient cases for medical necessity, appropriateness of care, and compliance with payer guidelines during non-standard business hours. You will analyze patient charts, interact with clinical staff, and document findings, often collaborating remotely with other care coordinators or medical teams. While much of the role is desk-based, quick decision-making and effective communication are essential due to faster-paced weekend workflows. This schedule can offer greater autonomy and flexibility, but may also require prioritizing tasks and managing multiple cases efficiently to ensure continuous patient care.
Success as a Weekend Utilization Review professional requires a strong background in nursing or healthcare, critical thinking skills, and a thorough understanding of medical necessity criteria, such as InterQual or Milliman guidelines. Familiarity with electronic medical records (EMR) systems and utilization management software is highly beneficial, and RN or healthcare-related licensure is often required. Exceptional communication, attention to detail, and the ability to work independently on weekends are crucial soft skills. Mastering these areas allows efficient and accurate reviews of patient care, supporting optimal healthcare resource allocation outside of standard work hours.
The most popular types of Utilization Review jobs in Rhode Island are:
For Weekend Utilization Review jobs in Rhode Island, the most frequently searched job titles are:
The top searched job categories for Weekend Utilization Review jobs in Rhode Island are:
Cities in Rhode Island with the most Weekend Utilization Review job openings:
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.
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US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.
It services
1,001 - 5,000 Employees
Jersey City, NJ, US
2000
