Utilization Review Jobs in USA

At Zelis we Get Stuff Done. So lets get to it!A Little About UsZelis is modernizing the healthcare financial experience across payers providers and healthcare consumers. We serve more than 750 payers including the top five national health plans regional health plans TPAs and millions of healthcare p...

Duties: The RN Inpatient Care Manager coordinates the care and services of selected member populations to facilitate a safe and timely transition to the next appropriate level of care. Clinically assesses plans implements coordinates monitors and evaluates options and services to meet an individua...

We are looking for an experienced and highly knowledgeable Nurse Consultant to provide expert clinical guidance support and insights across our healthcare programs and this remote role you will apply your nursing expertise to review clinical information improve patient care processes support decisi...

Work Schedule * 8:00am - 4:30pm - Full time hybrid position with weekend rotation required.The Utilization Review Nurse (RN) coordinates the care and service of selected patient populations across the continuum. He/ she works collaboratively with physicians and other members of the health care team...

Hours: Full-time 35 HoursWork Location: 30-30 Thomson Avenue LIC NY 11101Only candidates who are permanent in the Administrative Project Manager title or those who are reachable on the Promotional List (Exam #8529) or the Open-Competitive List (Exam #8042) may apply. Please include a copy of your N...

Site: Mass General Brigham Health Plan Holding Company Inc.Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and com...

Site: Mass General Brigham Health Plan Holding Company Inc.Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and com...

BronxWorks helps individuals and families improve their economic and social well-being. From toddlers to seniors we feed shelter teach and support our neighbors to build a stronger all aspects of our work we strive for the highest ethical and performance standards and are guided by the belief that...

Are you an internal caregiver student or contingent worker/agency worker at UMass Memorial Health CLICK HERE to apply through your Workday account.Exemption Status:ExemptHiring Range:$122387.20 - $220272.00Please note that the final offer may vary within this range based on a candidates experience s...

Where Youll WorkFounded in 1923 Dignity Health - St. Mary Medical Center is a 389-bed acute care nonprofit hospital located in Long Beach California. Serving over 50000 patients annually the hospital offers a full complement of services including a Level II Trauma Center Level III NICU heart care an...

DescriptionUnder broad direction from the Centralized Utilization Management Manager is responsible for the hospital-wide Utilization Management Programs in a general acute care hospital which serves infant pediatric adolescent young adult adult and geriatric patients. Incumbent of this position is...

Location:Geisinger Healthplex State CollegeShift:Days (United States of America)Scheduled Weekly Hours:0Worker Type:RegularExemption Status:NoJob Summary:This is an excellent opportunity to join our pharmacy team and practice at the top of license with a flexible schedule!Functions as a pharmacist a...

OverviewClinical Appeals Analyst (Remote) - FTThe Clinical Appeals Specialist is responsible for assisting the Corporate Director of Appeals Management (hereafter known as Director) by conducting a comprehensive analytic review of clinical documentation and complete the appeal process. The Clinical...

We anticipate the application window for this opening will close on - 5 Jan 2026At Medtronic you can begin a life-long career of exploration and innovation while helping champion healthcare access and equity for all. Youll lead with purpose breaking down barriers to innovation in a more connected co...

The Utilization Review Specialist nurse (UR RN) is responsible for monitoring adherence to the Utilization Review Plan (UR Plan) to ensure the effective and efficient use of hospital resources and services and to monitor the appropriateness of hospital admissions and continued stay. The individual i...

The Utilization Review Specialist nurse (UR RN) is responsible for monitoring adherence to the Utilization Review Plan (UR Plan) to ensure the effective and efficient use of hospital resources and services and to monitor the appropriateness of hospital admissions and continued stay. The individual i...

We are seeking a Community Behavioral Health Worker! Perry County OH Join our Team! Integrated Services for Behavioral Health (ISBH) is a community-minded forward-thinking behavioral health organization helping people along the road to health and well-being. We meet people in their homes and communi...

This role offers a range of $69000 to $75000 annually. Actual compensation will be based on qualifications such as experience education certifications and skills as well as geographic considerations.As a Project Coordinator at INXs West Chicago IL facility your role involves overseeing multiple proj...

The primary role of the Manager Care Advice Line will be responsible for managing the team that provides our patients with on-demand telephone-based care management services through a 24/7 Nurse Advice Line (i.e. telephone triage). Care Managers will assess symptoms/concerns of callers to determine...

DescriptionWe are the movers of the world and the makers of the future. We get up every day roll up our sleeves and build a better world -- together. At Ford were all a part of something bigger than ourselves. Are you ready to change the way the world movesAs a global leader in advanced mobility sol...