Utilization Review Nurse
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Raleigh, NC · On-site
Utilization Review Nurse (RN) A Few Words About Us - Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has ...
Raleigh, NC · On-site
Utilization Review Nurse (RN) A Few Words About Us - Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has ...
Raleigh, NC · On-site
Utilization Review Nurse (RN) A Few Words About Us - Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has ...
Raleigh, NC · On-site
Utilization Review Nurse (RN) A Few Words About Us - Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has ...
Raleigh, NC · On-site
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
Raleigh, NC · On-site
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
... review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with standard shift ... Weekend shift hours may vary. How you will make an impact: * Managing incoming calls or incoming ...
... review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with standard shift ... Weekend shift hours may vary. How you will make an impact: * Managing incoming calls or incoming ...
... review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with standard shift ... Weekend shift hours may vary. How you will make an impact: * Managing incoming calls or incoming ...
... review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with standard shift ... Weekend shift hours may vary. How you will make an impact: * Managing incoming calls or incoming ...
Clinical Review Nurse - Concurrent Review Location: Remote -Anywhere in US Shift : Tuesday ... Coordinates with interdepartmental teams on training needed within the utilization management team ...
Clinical Review Nurse - Concurrent Review Location: Remote -Anywhere in US Shift : Tuesday ... Coordinates with interdepartmental teams on training needed within the utilization management team ...
Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures. * Identifies potential Third-Party ...
Quick apply
Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures. * Identifies potential Third-Party ...
... review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with standard shift ... Weekend shift hours may vary. How you will make an impact: * Managing incoming calls or incoming ...
... review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with standard shift ... Weekend shift hours may vary. How you will make an impact: * Managing incoming calls or incoming ...
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Morrisville, NC · On-site
$85 - $105/hr
Conduct utilization reviews to monitor adherence to clinical practice guidelines * Notify members of adverse benefit determinations while preserving members' Due Process rights * Ensure compliance ...
New
Morrisville, NC · On-site
$85 - $105/hr
Conduct utilization reviews to monitor adherence to clinical practice guidelines * Notify members of adverse benefit determinations while preserving members' Due Process rights * Ensure compliance ...
New
$20.67 - $24.85
2% of jobs
$24.85 - $29.04
9% of jobs
$31.90 is the 25th percentile. Wages below this are outliers.
$29.04 - $33.22
21% of jobs
The median wage is $36.60 / hr.
$33.22 - $37.40
23% of jobs
$37.40 - $41.58
13% of jobs
$44.83 is the 75th percentile. Wages above this are outliers.
$41.58 - $45.76
10% of jobs
$45.76 - $49.94
8% of jobs
$49.94 - $54.12
5% of jobs
$54.12 - $58.30
5% of jobs
$58.30 - $62.48
2% of jobs
$62.48 - $66.67
2% of jobs
$20
$40
$66
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 Durham, NC are:
For Weekend Utilization Review jobs in Durham, NC, the most frequently searched job titles are:
The top searched job categories for Weekend Utilization Review jobs in Durham, NC are:
Cities near Durham, NC with the most Weekend Utilization Review job openings:

8.6
Based on 5 frontline employees who took The Breakroom Quiz
Position Summary:
Conducts patient reviews as specified in review plan using screening criteria; identifies and documents actual and potential delays in services or treatment and works with departments and other providers to resolve problems; communicates to attending physician need for documentation for admission or continuation of hospitalization; refers cases that do not meet criteria to Director when needed. Screens all cases against high risk screens for discharge planning; conduct concurrent and retrospective reviews.
Qualifications:
North Carolina License as a Registered Nurse. Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization management criteria and standards. Excellent communication skills. Ability to work with physicians and hospital staff. Maintains professional knowledge and skills related to areas of responsibility. Self direction with the ability to work with minimal supervision and manage multiple tasks. Demonstrates understanding of variations in care of the following age groups - newborn, infant, child, adolescent, adult and geriatric.
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