48 Healthcare Utilization Review jobs

United States (Remote)

Overview The Manager, Utilization Review Nursing is responsible for the operational oversight and leadership of Sendero Health Plans’ Utilization…

United States (Remote)

$63.1–94.7K / year

Thank you for considering a career at Ensemble!

United States (Remote)

$70–75K / year

The Utilization Management Registered Nurse is responsible for performing utilization review activities in compliance with federal and state…

United States (Remote)

By joining Sedgwick, you'll be part of something truly meaningful.

United States (Remote)

$100–130K / year

At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors.

United States (Remote)

$75.3–135.4K / year

Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members.

United States (Remote)

$35.00 – $40.00 / hour

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw…

United States (Remote)

To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here .

United States (Remote)

$71.1–97.8K / year

Become a part of our caring community The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the…

United States (Remote)

JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care…

United States (Remote)

$66.3–84K / year

To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here .

United States (Remote)

$70–75K / year

The Utilization Management Registered Nurse is responsible for performing utilization review activities in compliance with federal and state…

Riverside, California, US (Hybrid)

Job Description Job Summary Provides support for clinical facility site reviews.

United States (Remote)

$80K / year

Applicants must reside in: Michigan, Florida, Idaho, Texas, Minnesota or Illinois.

United States (Remote)

$34.00 – $61.00 / hour

Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals.

United States (Remote)

$27.00 – $49.00 / hour

Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating…

United States (Remote)

$27.00 – $49.00 / hour

Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance…

United States (Remote)

$31.00 / hour

At Broadway Ventures , we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions.

United States (Remote)

$65–70K / year

Scope: The Medical Review Specialist is a Registered Nurse who conducts the Utilization Review process by obtaining medical information and…

Florida, US (Hybrid)

$71.2–115.7K / year

The CRN is responsible for performing medical reviews using established criteria to ensure the member is receiving care at the most appropriate level.