• HCA Healthcare (Richmond, VA)
    …acute inpatient rehabilitation services prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong ... Clinical Rehab Specialist Prn This position acts as a coordinator...referral source within 2 hours. Performs on-site and off-site review of patients in designated facilities to assist Case… more
    Upward (07/28/25)
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  • Northwestern Memorial Healthcare (Winfield, IL)
    …Preferences for the Emergency Room and the Pediatric Emergency Room: Trauma Nurse Specialist (TNS) Emergency Communications Registered Nurse Certified ... Preferences for the Emergency Room and the Pediatric Emergency Room Trauma Nurse Specialist (TNS) Emergency Communications Registered Nurse Certified… more
    Upward (07/19/25)
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  • Conifer Health Solutions (Federal Way, WA)
    …DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Record Review : Completes initial medical records reviews of patient records within 24-48 ... assignment, risk of mortality and severity of illness; and (b) initiate a review worksheet. Conducts follow-up reviews of patients every 2-3 days to support and… more
    Upward (07/23/25)
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  • Reef Systems (Montgomery, AL)
    …Staff (ProStaff) meetings. Identify and notify the Government MTF case manager, Utilization Management (UM) nurse or Primary Care Management (PCM) team, ... Licensed Practical Nurse (LPN) - Maxwell AFB, AL Reef Systems...for telephonic, electronic, and in person access. Process and review referrals in Government information systems including, but not… more
    Upward (07/09/25)
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  • UF Health (Gainesville, FL)
    …recent clinical experience in a hospital setting. Certified Clinical Documentation Specialist (CCDS) preferred. Utilization Management, Case Management, Quality ... Responsible for facilitating improvement in inpatient clinical documentation through concurrent review of the medial record for accurate physician documentation of… more
    Upward (07/19/25)
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  • Lifepoint Health (Johnstown, PA)
    …care of hospitalized patients. Our team of RN Case Managers, Social Workers, Utilization Review staff, and Discharge Planners assure that payer requirements are ... Description Registered Nurse (RN), Case Manager Job Type: Full-time |M-F...of those we serve. Connect with our RN recruiting specialist Not ready to complete an application, or have… more
    Upward (07/25/25)
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  • Sanford Health (Bismarck, ND)
    …Summary Responsible for analyzing and synthesizing of data to maximize utilization of data in clinical decision-making, business and strategic initiative. ... team in grant post award activities, maintain grant and contract files, review contracts, develops progress reports, and reviews closed grant for completeness.… more
    Upward (07/20/25)
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  • Regency Integrated Health Services (Austin, TX)
    …Nursing Center - Austin, TX Position Type Full Time Job Category Nurse Description Primary Responsibilities Responsible for the coordination of the Resident ... and benefit period through regular communications with Regional Care Management Specialist , Business Office and external Case Managers. Gathers information needed… more
    Upward (07/28/25)
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  • Amazon (Doylestown, PA)
    …experience in occupational health, worker compensation, disability, health case management, or utilization review . 3+ years clinical work experience Good to ... management experience (STD/LTD claims) Knowledge of FMLA, ADAAA, EEOC, OFCCP regulations Utilization review experience CCM or CDMS certification Experience in… more
    Upward (07/28/25)
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  • Amergis Healthcare Staffing (Pittsburgh, PA)
    …and referrals for psychosocial needs Participates in Quality Assurance and Utilization Review activities, as directed Empowers patients in decision-making ... continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Essential… more
    Upward (07/27/25)
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  • VetJobs (Beverly Hills, CA)
    …experience required 3 years of previous experience in case management, discharge planning, utilization review , and HMO in the acute inpatient or outpatient ... their needs, coordinating care, communicating with health plans (including concurrent review , which assists the hospitalist/ specialist and case manager to… more
    Upward (07/28/25)
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  • Regency Pacific Management, LLC (Bellevue, WA)
    Registered Nurse License Required! Must have a Minimum of 5 years of MDS experience. Multfacility Oversight - 75% Travel Reimbursement Specialist - Skilled ... Nursing Extensive Overnight Travel Throughout Oregon The Reimbursement Specialist is responsible for multi-facility oversight of the RAI process, ensuring accuracy… more
    Upward (07/25/25)
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  • Atlantic Health System (Livingston, NJ)
    …plan, including transfer eligibility, level of care, resource prioritization & utilization , timely acceptance, and appropriate priority and mode of transport. Acts ... appropriate transport priority and mode, while considering appropriate resource utilization and timeliness of transfer. Communicates transport information to… more
    Upward (07/21/25)
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  • Utilization Review Specialist

    Houston Methodist (Sugar Land, TX)
    At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point ... this position is able to cover a multitude of utilization review functions through point of entry,...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
    Houston Methodist (07/29/25)
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  • Utilization Management Nurse

    LA Care Health Plan (Los Angeles, CA)
    Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
    LA Care Health Plan (07/08/25)
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  • RN Utilization Review

    HonorHealth (AZ)
    …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
    HonorHealth (06/11/25)
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  • Utilization Review Specialist

    Nuvance Health (Danbury, CT)
    …other duties as required. Education: ASSOCIATE'S LVL DGRE Required: 3 Years of Utilization Review experience(or a certification ACMA, MCG, Interqual) Required : ... (2nd week) ; rotate one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, and… more
    Nuvance Health (07/03/25)
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  • Registered Nurse Utilization

    LifePoint Health (Louisburg, NC)
    …a valid job field* **Organization:** **Maria Parham Franklin* **Title:** *Registered Nurse Utilization Review Coordinator* **Location:** *NC-Louisburg* ... Registered Nurse (RN) Utilization Review ...Registered Nurse (RN) Utilization Review Job Type: Full Time...of those we serve. Connect with our RN recruiting specialist . Do you need more time to complete an… more
    LifePoint Health (05/15/25)
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  • System Utilization Management SUM…

    Alameda Health System (Oakland, CA)
    …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating in ... System Utilization Management SUM Specialist + Oakland,...Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical necessity… more
    Alameda Health System (07/19/25)
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  • Insurance Specialist -Mount Sinai West-…

    Mount Sinai Health System (New York, NY)
    **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by ... Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical/Technical/Service**… more
    Mount Sinai Health System (07/23/25)
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