Beaver, PA · On-site
The Director of Utilization Review (UR) is to manage effectively and efficiently all aspects of the MDS/ Case management / Restorative/ Care planning/ 5 Star and Quality Measures while capturing ...
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Beaver, PA · On-site
The Director of Utilization Review (UR) is to manage effectively and efficiently all aspects of the MDS/ Case management / Restorative/ Care planning/ 5 Star and Quality Measures while capturing ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Mars, PA · On-site
Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Mars, PA · On-site
Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Pittsburgh, PA · On-site
$34.49 - $56.83/hr
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
Pittsburgh, PA · On-site
$34.49 - $56.83/hr
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
Pittsburgh, PA · On-site
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
Pittsburgh, PA · On-site
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
Pittsburgh, PA · Remote
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
Pittsburgh, PA · Remote
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
Pittsburgh, PA · On-site +1
$40 - $42/hr
Comfort with technology and electronic medical records Experience in utilization review, case management, quality improvement, compliance, or claims review is a plus-but not required. Why Join Us
Pittsburgh, PA · On-site +1
$40 - $42/hr
Comfort with technology and electronic medical records Experience in utilization review, case management, quality improvement, compliance, or claims review is a plus-but not required. Why Join Us
Pittsburgh, PA · On-site
Comfort with technology and electronic medical records Experience in utilization review, case management, quality improvement, compliance, or claims review is a plus-but not required. Why Join Us
Pittsburgh, PA · On-site
Comfort with technology and electronic medical records Experience in utilization review, case management, quality improvement, compliance, or claims review is a plus-but not required. Why Join Us
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
$20.77 - $24.97
2% of jobs
$24.97 - $29.17
9% of jobs
$32.05 is the 25th percentile. Wages below this are outliers.
$29.17 - $33.37
21% of jobs
The median wage is $36.77 / hr.
$33.37 - $37.57
23% of jobs
$37.57 - $41.77
13% of jobs
$45.04 is the 75th percentile. Wages above this are outliers.
$41.77 - $45.97
10% of jobs
$45.97 - $50.17
8% of jobs
$50.17 - $54.37
5% of jobs
$54.37 - $58.58
5% of jobs
$58.58 - $62.78
2% of jobs
$62.78 - $66.98
2% of jobs
$20
$41
$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 Pittsburgh, PA are:
For Weekend Utilization Review jobs in Pittsburgh, PA, the most frequently searched job titles are:
The top searched job categories for Weekend Utilization Review jobs in Pittsburgh, PA are:
Cities near Pittsburgh, PA with the most Weekend Utilization Review job openings:
Full-time
Posted 5 days ago
The Director of Utilization Review (UR) is to manage effectively and efficiently all aspects of the MDS/ Case management / Restorative/ Care planning/ 5 Star and Quality Measures while capturing clinical reimbursement. This should be done while following the RAI manual, DOH guidelines, CMS guidelines, Federal and State Guidelines and Corporate Compliance.
1) Graduate of an accredited School of Nursing with current Pennsylvania nursing license
2) Maintain CEU credits through seminars, in-service programs, and professional journals relative to professional growth
3) Strong knowledge of the RAI, MDS, state and federal guidelines, 5 star reporting and quality measures, and restorative nursing
