Utilization Review Jobs in USA

Hours:Shift Start Time:8 AMShift End Time:5 PMAWS Hours Requirement:8/40 - 8 Hour ShiftAdditional Shift Information:start and end time may vary by two hours before and/or after based on department needsWeekend Requirements:No WeekendsOn-Call Required:NoHourly Pay Range (Minimum - Midpoint - Maximum)...

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care of assigned patients and associated staff in accordance with physician orders and the plan of care per state Practice this role you will report to the Director of Nursing/Director of Patient Care Servi...

Anticipated End Date:Position Title:Plan Performance Medical Director- Missouri Medicaid MarketJob Description:Plan Performance Medical Director- Missouri Medicaid Market Location: This role enables associates to work virtually full-time with the exception of required in-person meetings providing ma...

SummaryWe are currently hiring for a Managed Care Coordinator II Utilization Management to join BlueCross BlueShield of South this role as a Managed Care Coordinator II Utilization Management you will review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria b...

DescriptionAssociate Medical Director Health Care Services (MD/CQCT)This recruitment is posted continuously. Application review will begin on6/11/2026and you are encouraged to submit your application materials as soon as possible. The hiring manager reserves the right to close the posting at any tim...

Skills: Five (5) years minimum of clinical experience as a Registered Nurse. Experience with Care Coordination Utilization review and discharge planning Computer literacy. Leadership experience. - preferred Education: Associates Degree (ASN ADN) from an accreditated Nursing Program. Bachelors...

### RTO after booking is NOT allowed and is NOT allowed to be worked out onsite. Any call-offs or additional RTO on unit could possibly turn into a Cancel and DNR ### ***BSN REQUIRED WITH 3 YEARS OF EXPERIENCE*** REQUIRED SKILLS / CERTS / EXP: Minimum Years of Experience: 3 Years Minimum REQUIRED -...

POSITION SUMMARY Incumbent serves as an Outpatient/Inpatient Nurse Case Manager as the supportive contact for specified groups of identified high risk patients; will specifically focus on specialty clinics that need specific Case Management attention. The case manager meets essential health and soci...

Job ID: OR() Remote/Local Medicaid BI/DW Developer with data analysis SQL Server Python/Java/R SAS ETL migration AWS MMIS Azure DevOps GIT. Jupyter Notebooks Hadoop Spark/Hive/Pig and agile experience Location: Salem OR (DHS / OHA) Duration: 17 Months Skills: Database Data Analysis Proficient (4-6 Y...

The Case Manager reflects the mission vision and values of NM adheres to the organizations Code of Ethics and Corporate Compliance Program and complies with all relevant policies procedures guidelines and all other regulatory and accreditation standards.Under the general supervision of the Director...

Our StoryImagine being part of a team thats not just shaping the future but actively driving it. At Davies North America were at the forefront of innovation and excellence blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group we help busines...

DescriptionYour experience mattersBeckett Springs is part ofLifepoint Health a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Housekeeperjoining our team...

Job Title: Registered Nurse (RN) Utilization ReviewLocation: Apple Valley CADuration: 13-Week ContractSchedule: Day Shift 5x8-Hour ShiftsHours: 8:00 AM 4:30 PMGuaranteed Hours: 40 Hours WeeklyPosition OverviewWe are seeking an experienced Utilization Review Registered Nurse (RN) to support care m...

Title: RN / MSW Care Coordination / Case Management ContractLocation: Everett Washington (Level II Trauma Center Multi Campus Facility)Duration: 13 WeeksPayrate:Starting at 45$/hourShift: 4x10 Day Shift (Start ASAP)Position OverviewNavitas Healthcare LLC is seeking an experienced RN or MSW for a...

Job Title: Registered Nurse Case ManagerLocation: Syracuse NYDuration: 13 Weeks (Extendable)Shift: Day Shift 5x8 Hours (7:00 AM 3:00 PM)CompensationLocal Candidates: $57 $59 per hourTravel Candidates: $65 $67 per hourPosition OverviewThe Registered Nurse (RN) Case Manager is responsible for co...

SummaryThe Clinical Appeals Coordinator is responsible for supporting Concord Hospital with claim appeal activities within the Revenue Integrity department. This involves a timely and accurate review of medical records in response to claim denials received from third party payers Recovery Audit Cont...

Location:Geisinger ConvenientCare DallasShift:Days (United States of America)Scheduled Weekly Hours:24Worker Type:RegularExemption Status:YesJob Summary:Functions as a pharmacist at the Retail Site Pharmacy and provides efficient accurate and safe medication services to patient/customers by filling...

Hours:Shift Start Time:8 AMShift End Time:5 PMAWS Hours Requirement:8/40 - 8 Hour ShiftAdditional Shift Information:Weekend Requirements:No WeekendsOn-Call Required:NoHourly Pay Range (Minimum - Midpoint - Maximum):$30.370 - $37.950 - $42.510The stated pay scale reflects the range that Sharp reasona...

Who We Are:SAC Health empowers our patients and their families to live vibrant and healthy lives through culturally responsive exceptional care. Patient-centered whole-person care. Our unique full scope team-based approach is what makes SAC Health the provider of choice for patients. Top-Tier Patien...

Weve made a lot of progress since opening the doors in 1942 but one thing has never changed - our commitment to serve heal lead educate that every award earned every record broken and every patient helped is because of the dedicated employees who fill our hallways. At Ochsner whether you work with...