Rochester, NY · On-site
$26.41 - $61.79/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
Rochester, NY · On-site
$26.41 - $61.79/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
Webster, NY · On-site
$2.0K/wk
Utilization Review * Discipline: Therapy * Start Date: ASAP * Duration: 13 weeks * 40 hours per week * Shift: 8 hours, nights * Employment Type: Travel Benefits: * Day 1 Insurance * Cigna medical ...
Webster, NY · On-site
$2.0K/wk
Utilization Review * Discipline: Therapy * Start Date: ASAP * Duration: 13 weeks * 40 hours per week * Shift: 8 hours, nights * Employment Type: Travel Benefits: * Day 1 Insurance * Cigna medical ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
Canandaigua, NY · On-site
$35 - $47/hr
Perform extensive record review in accordance with state regulations, ensuring compliance with ... Shared weekends Position Pay Range: $35.00-47.00/hour Starting Pay: Based on experience Thompson ...
Canandaigua, NY · On-site
$35 - $47/hr
Perform extensive record review in accordance with state regulations, ensuring compliance with ... Shared weekends Position Pay Range: $35.00-47.00/hour Starting Pay: Based on experience Thompson ...
Perform extensive record review in accordance with state regulations, ensuring compliance with ... Shared weekends Position Pay Range: $35.00-47.00/hour Starting Pay: Based on experience Thompson ...
Perform extensive record review in accordance with state regulations, ensuring compliance with ... Shared weekends Position Pay Range: $35.00-47.00/hour Starting Pay: Based on experience Thompson ...
Canandaigua, NY · On-site
$35 - $47/hr
Perform extensive record review in accordance with state regulations, ensuring compliance with ... Shared weekends Position Pay Range: $35.00-47.00/hour Starting Pay: Based on experience Thompson ...
Canandaigua, NY · On-site
$35 - $47/hr
Perform extensive record review in accordance with state regulations, ensuring compliance with ... Shared weekends Position Pay Range: $35.00-47.00/hour Starting Pay: Based on experience Thompson ...
Canandaigua, NY · On-site
Perform extensive record review in accordance with state regulations, ensuring compliance with ... Shared weekends Position Pay Range: $35.00-47.00/hour Starting Pay: Based on experience Thompson ...
Canandaigua, NY · On-site
Perform extensive record review in accordance with state regulations, ensuring compliance with ... Shared weekends Position Pay Range: $35.00-47.00/hour Starting Pay: Based on experience Thompson ...
Rochester, NY · On-site
$41.93 - $54.51/hr
D/E/N weekends and holidays as required. Straight Night and Evening shifts available.ResponsibilitiesUnique offering to explore the rewarding nursing care of cardiac patients throughout our Cardiac ...
Rochester, NY · On-site
$41.93 - $54.51/hr
D/E/N weekends and holidays as required. Straight Night and Evening shifts available.ResponsibilitiesUnique offering to explore the rewarding nursing care of cardiac patients throughout our Cardiac ...
$38.76 - $50.39/hr
D/E/N weekends and holidays as required. Straight Night and Evening shifts available.ResponsibilitiesUnique offering to explore the rewarding nursing care of cardiac patients throughout our Cardiac ...
$38.76 - $50.39/hr
D/E/N weekends and holidays as required. Straight Night and Evening shifts available.ResponsibilitiesUnique offering to explore the rewarding nursing care of cardiac patients throughout our Cardiac ...
Rochester, NY · On-site
$38.76 - $50.39/hr
D/E/N weekends and holidays as required. Straight Night and Evening shifts available. Responsibilities Unique offering to explore the rewarding nursing care of cardiac patients throughout our Cardiac ...
Rochester, NY · On-site
$38.76 - $50.39/hr
D/E/N weekends and holidays as required. Straight Night and Evening shifts available. Responsibilities Unique offering to explore the rewarding nursing care of cardiac patients throughout our Cardiac ...
Rochester, NY · Remote
$69K - $92K/yr
Ideal for experienced RNs looking to expand into utilization management, this position provides ... Reviews inpatient medical records against established criteria and standards to determine medical ...
Rochester, NY · Remote
$69K - $92K/yr
Ideal for experienced RNs looking to expand into utilization management, this position provides ... Reviews inpatient medical records against established criteria and standards to determine medical ...
Flexible hours are provided with the need of one weekend day and some evenings. In-person and ... Engage in the Utilization Review process for assigned cases every month * Respond to clinical ...
Quick apply
Apply Early
Flexible hours are provided with the need of one weekend day and some evenings. In-person and ... Engage in the Utilization Review process for assigned cases every month * Respond to clinical ...
Apply Early
Participates in utilization review and/or continuous quality improvement activities as requested ... Participates in on-call schedule and weekend/holiday schedule as assigned. * Consistently ...
Participates in utilization review and/or continuous quality improvement activities as requested ... Participates in on-call schedule and weekend/holiday schedule as assigned. * Consistently ...
Rochester, NY · On-site
$65K - $120K/yr
Flexible hours are provided with the need of one weekend day and some evenings. In-person and ... Engage in the Utilization Review process for assigned cases every month * Respond to clinical ...
Rochester, NY · On-site
$65K - $120K/yr
Flexible hours are provided with the need of one weekend day and some evenings. In-person and ... Engage in the Utilization Review process for assigned cases every month * Respond to clinical ...
Participates in utilization review and/or continuous quality improvement activities as requested ... Participates in on-call schedule and weekend/holiday schedule as assigned. * Consistently ...
Participates in utilization review and/or continuous quality improvement activities as requested ... Participates in on-call schedule and weekend/holiday schedule as assigned. * Consistently ...
Rochester, NY · On-site
$21 - $21.30/hr
This role is every other weekend on the overnight shift. Under the direction of the Residence ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...
Rochester, NY · On-site
$21 - $21.30/hr
This role is every other weekend on the overnight shift. Under the direction of the Residence ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...
Rochester, NY · On-site
$21 - $21.30/hr
This role is every other weekend on the overnight shift. Under the direction of the Residence ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...
Rochester, NY · On-site
$21 - $21.30/hr
This role is every other weekend on the overnight shift. Under the direction of the Residence ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...
Rochester, NY · On-site
$21 - $21.30/hr
This role is every other weekend on the overnight shift. Under the direction of the Residence ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...
Rochester, NY · On-site
$21 - $21.30/hr
This role is every other weekend on the overnight shift. Under the direction of the Residence ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...
$21.11 - $25.38
2% of jobs
$25.38 - $29.65
9% of jobs
$32.57 is the 25th percentile. Wages below this are outliers.
$29.65 - $33.92
21% of jobs
The median wage is $37.37 / hr.
$33.92 - $38.19
23% of jobs
$38.19 - $42.46
13% of jobs
$45.78 is the 75th percentile. Wages above this are outliers.
$42.46 - $46.72
10% of jobs
$46.72 - $50.99
8% of jobs
$50.99 - $55.26
5% of jobs
$55.26 - $59.53
5% of jobs
$59.53 - $63.80
2% of jobs
$63.80 - $68.07
2% of jobs
$21
$41
$68
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.
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.
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.
$26.41 - $61.79/hr
Full-time
This job post has expired today. Applications are no longer accepted.
8.1
Based on 193 frontline employees who took The Breakroom Quiz
143rd of 277 rated insurance
Job Summary
Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote the Molina care model.
Adheres to utilization management (UM) policies and procedures.
Required Qualifications
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
Certified Professional in Healthcare Management (CPHM).
Recent hospital experience in an intensive care unit (ICU) or emergency room.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $26.41 - $61.79 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Get the full story on Breakroom
Sourced by ZipRecruiter
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
