Utilization Review Nurse

Job SummaryUT Southwestern Medical Center is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate level of care while minimizing unnecessary hospital stays.Key ResponsibilitiesConduct medical certification reviews for medical necessity...

Job SummaryUT Southwestern Medical Center is seeking a skilled Registered Nurse to join our Utilization Review team. As a Utilization Review Registered Nurse, you will play a critical role in ensuring that patients receive the most appropriate level of care, while also promoting efficient use of healthcare resources.Key ResponsibilitiesConduct medical...

Job Title: Utilization Review NurseChildren's Health is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that our patients receive the most appropriate and effective care.Responsibilities:Conduct thorough reviews of patient records to determine medical necessity and...

Job SummaryWe are seeking a highly skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will be responsible for conducting medical certification reviews to determine the medical necessity of acute care services.Key ResponsibilitiesConduct inpatient admission reviews for Medicare and Medicaid beneficiaries, as well...

Job SummaryUT Southwestern Medical Center is seeking a skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will conduct medical certification reviews for medical necessity for acute care facilities and services, using nationally recognized, evidence-based guidelines approved by medical staff to recommend level of...

Job SummaryWe are seeking a skilled Clinical Review Nurse to join our team at AmTrust Financial Services. As a Clinical Review Nurse, you will play a critical role in reviewing medical necessity, appropriateness, quality, and efficiency of services for Workers' Compensation claimants.Key ResponsibilitiesPerform utilization review activities prospectively,...

Job Title: Clinical Review NurseAmTrust Financial Services is seeking a skilled Clinical Review Nurse to join our team. As a Clinical Review Nurse, you will play a critical role in reviewing medical necessity, appropriateness, quality, and efficiency of services for Workers' Compensation claimants.Key Responsibilities:Perform utilization review activities...

HEDIS Review Nurse Job DescriptionThis is a contracted position that will involve remote work. As a Registered Nurse (RN) or Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) with an unrestricted license in the state, you will be responsible for annual patient chart inspection/audit. The audits are conducted to ensure that providers (MDs)...

Job OpportunityWe are seeking a skilled Physician Reviewer to join our team at Dane Street, LLC.About the RoleThe successful candidate will utilize their clinical expertise to review insurance appeals, prospective and retrospective claims, and provide an interpretation of the medical necessity of services provided by other healthcare professionals.Key...

Job SummaryCorVel Corporation is seeking a highly skilled Clinical Review Specialist II to join our team. As a Clinical Review Specialist II, you will play a critical role in ensuring the medical necessity of in-patient admissions and out-patient treatment, while supporting the goals of our Case Management department.Key ResponsibilitiesConduct thorough...

Job SummaryWe are seeking a highly skilled and experienced Medical Review Specialist to join our team at Concentra Career Choice. As a Medical Review Specialist, you will be responsible for reviewing medical files and providing recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, and return to work, short and...

Job Title: Medical Review SpecialistConcentra is seeking a Medical Review Specialist to join our team. As a Medical Review Specialist, you will be responsible for reviewing medical files and providing recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family...

Job SummaryWe are seeking a highly skilled Utilization Review Nurse to join our team at Elite. As a key member of our clinical review team, you will play a critical role in ensuring the medical necessity of treatment requests submitted by providers, requestors, claimants, or carriers.Key ResponsibilitiesMedical Necessity Review: Conduct thorough evaluations...

About the RoleParkland Health & Hospital System is seeking a skilled Utilization Management Nurse to join our team. As a Utilization Management Nurse, you will play a critical role in ensuring that our members receive the most appropriate and effective care possible.Key ResponsibilitiesPerform utilization review activities, including pre-certification,...

Job Opportunity at Dane Street, LLCJob Title: Physician ReviewerJob Summary:Dane Street, LLC is seeking a highly skilled Physician Reviewer to join our team. As a Physician Reviewer, you will utilize your clinical expertise to review insurance appeals, prospective and retrospective claims, and provide an interpretation of the medical necessity of services...

Job SummaryWe are seeking a Board Certified Neurologist to join our medical review team as a Telehealth Medical Review Physician. This is a flexible, telecommute role that offers the ability to customize your schedule and caseload within a Monday - Friday work week and within business hours.ResponsibilitiesReviews medical files and provides recommendations...

About the RoleWe are seeking a highly skilled and experienced Pre-Service Review Coordinator to join our team at UnitedHealth Group. As a key member of our clinical review team, you will play a critical role in ensuring the medical appropriateness of pre-authorization requests.Key ResponsibilitiesReview and determine medical appropriateness of...

{"title": "Clinical Utilization Manager", "content": "About the JobKris Anderson Consulting, LLC is seeking a skilled Clinical Utilization Manager to join our team. As a Clinical Utilization Manager, you will be responsible for implementing and coordinating all utilization management functions relating to pre-certification of outpatient services.Key...

OverviewWe are seeking a skilled and experienced Board Certified Neurologist to join our medical review team as an independent contractor. As a Telehealth Physician Advisor, you will play a crucial role in reviewing health claims and providing medical interpretation and decisions about the appropriateness of services provided by other healthcare...

Job OverviewThis remote position allows for flexible scheduling and caseload management while adhering to client-required turnaround times. Reviewers are compensated on a per-case basis as independent contractors.Candidates must be a licensed Orthopedic Surgeon in Texas with experience in testimony, depositions, or counter affidavits. Access to a Texas...