Senior Nurse Reviewer

Concurrent Review NursePerforms concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to...

WNS, part of Capgemini, is seeking a Clinical Review Team Lead to serve as the clinical expert for prospective utilization review. The role balances production reviews with lead duties, coaching nurses, and ensuring timely case flow in a fast-paced environment. The ideal candidate is analytical, highly organized and experienced in utilization management,...

WNS, part of Capgemini, is seeking a Clinical Review Nurse for a fully remote, full-time role. You will perform prospective utilization reviews for HealthHelp’s programs, applying clinical guidelines and policies to decide medical necessity. Successful candidates will complete structured training and work toward production targets with QA oversight. The...

AvonRisk Utilization Review NurseAvonRisk is the nation's leading specialty risk manager for self-insured organizations, uniting respected regional leaders in workers' compensation, liability, managed care, and risk management across 32 states. With nearly 700 professionals and brands including Intercare, InterMed, George Hills, and AS&G Claims...

Corner Alliance is seeking a Merit Reviewer with 5+ years of experience to support a federal government grant program. The role is remote and full-time on a temporary basis, spanning December 7, 2026, to May 14, 2027. You will conduct independent merit reviews, score applications, and provide written justifications, while following a guide and QA practices....

Ensemble Health Partners is seeking an experienced RN for Utilization Review to assess medical necessity and optimize hospital and patient care. This remote role involves coordinating with the FCC, care management, and interdisciplinary teams to ensure appropriate level of care across cases. The candidate should hold an active RN license with 3+ years of...

To support client needs in hospital claims, the full-time remote State Licensed Nurse Reviewer will analyze claims data, identify billing errors, and negotiate adjustments with claims administrators on behalf of ASO clients. Key Responsibilities Perform detailed audits of hospital claims, including itemized bills and medical records, to validate billing...

A-Line Staffing Solutions is seeking a Clinical Review Nurse for a concurrent review role in a remote-capable setting. The RN will assess member eligibility through chart review and coordinate with providers to gather necessary information. You will document findings and ensure compliance with regulatory and insurance guidelines while collaborating with...

Secondary Review Nurse At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a...