• Lifepoint Health (Louisburg, NC)
    Description Registered Nurse (RN) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound ... of those we serve. Connect with our RN recruiting specialist . Do you need more time to complete an...the responsibilities involved in monitoring adherence to the hospital's utilization review plan, which ensures the appropriate… more
    Upward (06/27/25)
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  • Conifer Health Solutions (Sherwood, AR)
    …DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Record Review : Completes initial medical records reviews of patient records within 24-48 ... hours of admission for a specified patient population to: (a) evaluate...mortality and severity of illness; and (b) initiate a review worksheet. Conducts follow-up reviews of patients every 2-3… more
    Upward (06/24/25)
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  • SafeHorizon (New York, NY)
    …fashion and accurate manner; Provide starter kits, assisting with bed utilization by helping with apartment preparation and cleaning; moving clients' belongings ... Provide client accompaniment to important appointments when requested; Assist with admission and discharge of clients. This may include, providing childcare,… more
    Upward (07/01/25)
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  • Regency Integrated Health Services (Cuero, TX)
    …status during the entire assessment period. ** Participates in the pre- admission process to ensure essential information needed for MDS/Case Mix optimization ... and benefit period through regular communications with Regional Care Management Specialist , Business Office and external Case Managers. Gathers information needed… more
    Upward (07/21/25)
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  • CAMC Health System (Weston, WV)
    …reflected. Works directly with House Supervisors to provide appropriate and timely admission to the facility taking into account current census, inpatient emergency ... include all ICARE Values, culture of 'yes' to accommodate physician partners/patient admissions . Provides timely feedback to staff and works to support their… more
    Upward (07/09/25)
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  • Utilization Review Specialist

    Spectrum Billing Solutions (Skokie, IL)
    …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization ... and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
    Spectrum Billing Solutions (06/06/25)
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  • Utilization Review Specialist

    Hunterdon Health Care System (Flemington, NJ)
    Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure the effective and efficient ... use of hospital services and monitors the appropriateness of hospital admissions and extended hospital stays. The evaluation of the appropriateness and medical… more
    Hunterdon Health Care System (06/13/25)
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  • Utilization Review Specialist

    BriteLife Recovery (Englewood, NJ)
    What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is ... responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients...and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions ,… more
    BriteLife Recovery (07/03/25)
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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)
    …by using bench marked evidence-based criteria (ie, InterQual/MCG). Responsibilities: 1)Ensures that Admission Review using InterQual, or MCG is completed within ... other duties as required. Education: ASSOCIATE'S LVL DGRE Required: 3 Years of Utilization Review experience(or a certification ACMA, MCG, Interqual) Required :… more
    Nuvance Health (07/03/25)
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  • Utilization Review RN

    Catholic Health Initiatives (Omaha, NE)
    …2 hours of a Commonspirit Health Facility Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact ... our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! As our… more
    Catholic Health Initiatives (06/21/25)
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  • UR Clinical Specialist

    Community Health Systems (Franklin, TN)
    **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services ... to ensure compliance with utilization management policies. This role conducts admission ...healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence… more
    Community Health Systems (07/09/25)
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  • PRN UR Coordinator

    Community Health Systems (Franklin, TN)
    …timely authorizations for hospital admissions and extended stays. The Utilization Review Coordinator monitors and documents all authorization activities, ... authorizations and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist . +...Degree preferred + 0-2 years of work experience in utilization review , hospital admissions or… more
    Community Health Systems (07/02/25)
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  • System Utilization Management SUM…

    Alameda Health System (Oakland, CA)
    review of requests that may not meet medical necessity criteria. 4. Review admission orders and documentation to confirm alignment with regulatory ... System Utilization Management SUM Specialist + Oakland,...and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of… more
    Alameda Health System (07/19/25)
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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 Type: ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,... in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates with… more
    LA Care Health Plan (07/08/25)
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  • Utilization Management Specialist

    Mount Sinai Health System (New York, NY)
    **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
    Mount Sinai Health System (07/12/25)
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  • Registered Nurse Utilization Review

    LifePoint Health (Louisburg, NC)
    Registered Nurse (RN) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound commitment to ... of those we serve. Connect with our RN recruiting specialist . Do you need more time to complete an...the responsibilities involved in monitoring adherence to the hospital's utilization review plan, which ensures the appropriate… more
    LifePoint Health (05/15/25)
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  • Clinical Rehab Specialist PRN

    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 ... Specialist will assist and coordinate the in-take and pre- admission screening process. The Clinical Rehabilitation Specialist accurately documents… more
    HCA Healthcare (06/21/25)
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  • Assessment Specialist PRN

    HCA Healthcare (Nashville, TN)
    …for patients in regard to managed care organizations + Conducts utilization review for managed care cases in admissions /intake department + Willingness to ... treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile… more
    HCA Healthcare (06/21/25)
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  • Full Time Home Health Quality Specialist

    Penn Medicine (Lancaster, PA)
    …day. Are you living your life's work? Summary: + The Home Health Quality Specialist is responsible for collaborating with clinicians at established points in time to ... and development of effective plans of care to assure appropriate utilization and promote appropriate qualitypatient care and positive patient outcomes.… more
    Penn Medicine (07/11/25)
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