• Elliot Health System (Bedford, NH)
    …quality, risk management, utilization , infection control and resource utilization etc. Participates in multidisciplinary meetings to review ... more
    JobGet (03/22/25)
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  • Utilization Review Medical

    Intermountain Health (Las Vegas, NV)
    …health care organizations, which includes Medicare coverage criteria. **Job Profile:** Performs medical review activities pertaining to utilization review ... more
    Intermountain Health (03/04/25)
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  • Utilization Management Specialist, ED (RN…

    Vanderbilt University Medical Center (Nashville, TN)
    …that the appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for ... more
    Vanderbilt University Medical Center (02/20/25)
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  • Medical Director- Utilization

    AnMed Health (Anderson, SC)
    The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... more
    AnMed Health (01/21/25)
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  • Utilization Review Nurse

    MD Anderson Cancer Center (Houston, TX)
    …clinical information as required to support medical necessity for services Ensures utilization review case closures are completed within 4 business days post ... more
    MD Anderson Cancer Center (03/21/25)
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  • Utilization Review Nurse

    Independent Health (Buffalo, NY)
    …collaboration. **Overview** The Utilization Review Nurse (URN) performs clinical review to determine the medical necessity of requested services. The URN ... more
    Independent Health (03/14/25)
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  • Utilization Review (UR) Specialist

    Spectrum Billing Solutions (Skokie, IL)
    …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... more
    Spectrum Billing Solutions (02/05/25)
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  • Medical Director, Commercial Line…

    Excellus BlueCross BlueShield (Rochester, NY)
    …II (in addition to Level I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of ... more
    Excellus BlueCross BlueShield (02/19/25)
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  • Case Manager Utilization Review

    Beth Israel Lahey Health (Burlington, MA)
    …a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in Burlington Hospital ... more
    Beth Israel Lahey Health (01/15/25)
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  • Medical Review Coordinator II…

    Prime Healthcare (Joliet, IL)
    Medical Graduate, Dental Graduate, PA, or Nursing Graduate required. 2. Three years of Utilization Review experience as a Medical Review Coordinator - ... more
    Prime Healthcare (03/17/25)
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  • Reviewer I, Medical

    ManpowerGroup (Columbia, SC)
    …to effectively communicate with members and healthcare providers. **Key Responsibilities** ✔ ** Medical Review & Utilization Management (80%)** + Perform ... more
    ManpowerGroup (01/31/25)
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  • Remote Care Review Processor

    Insight Global (Long Beach, CA)
    …role within the healthcare industry - Care Review , Care Coordinator, Medical Assistant, Patient Services, Utilization Review , Authorization, Eligibility, ... more
    Insight Global (03/18/25)
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  • Genetic Counselor Clinical Reviewer - EviCore…

    The Cigna Group (Bloomfield, CT)
    …by a supervisor in Utilization Management. Handles moderately complex medical review , utilization review , credentialing/re-credentialing, quality ... more
    The Cigna Group (03/05/25)
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  • Art Therapist

    SUNY Upstate Medical University (Syracuse, NY)
    …patients, maintaining accurate attendance and therapy records. Interfaces with nursing, medical staff, utilization review social services, discharge ... more
    SUNY Upstate Medical University (02/05/25)
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  • Workers Compensation Claims Manager

    Public Storage (Plano, TX)
    …+ Oversee reporting of claims and compliance with state filing requirements + Oversee medical utilization + Review and analyze all claims; identify claims ... more
    Public Storage (03/21/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Kenosha, WI)
    …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two ... more
    Molina Healthcare (01/25/25)
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  • Vice President, Chief Medical Officer,…

    Hackensack Meridian Health (Hackensack, NJ)
    …including Hospitalists, to ensure appropriate length of stay, time of day discharge, medical chart completion, and utilization review . **Regulatory Affairs** ... more
    Hackensack Meridian Health (03/14/25)
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  • Access Service Representative-Pyr Focus…

    Sharp HealthCare (San Diego, CA)
    …all accounts in rep assignment or alpha split. Contact hospital departments such as Medical Records, Utilization Review or external review organizations ... more
    Sharp HealthCare (03/21/25)
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  • RN Discharge Planner

    Ochsner Health (New Orleans, LA)
    …basis. When needed will assist with daily clinical review of patient's medical records for utilization review purposes. Works independently with minimal ... more
    Ochsner Health (02/06/25)
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  • Utilization Review Nurse Supervisor…

    The County of Los Angeles (Los Angeles, CA)
    UTILIZATION REVIEW NURSE SUPERVISOR II Print...over the nursing staff engaged in utilization review activities at Los Angeles General Medical ... more
    The County of Los Angeles (12/29/24)
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