Review Nurse Jobs in the United States
Lumen Solutions Group, Inc.
Baltimore, MD
We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation.
Kaiser Permanente
Wailuku, HI
Supports high-quality consultation by: communicating with physicians, managers, staff, members, and/or caregivers regarding requirements related to medical necessity and benefit denials across the continuum of care, under direct supervision; and leveraging working knowledge to ensure the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and coverage by members and physicians. In addition to the responsibilities listed below, this position is also responsible for leveraging clinical knowledge of evidence-based guidelines, insurance policies, and clinical criteria to consult on the medical necessity, level of care, and duration of treatment required for basic reviews, and collaborating with the health care team, members, and caregivers to assist in discharge planning, cost of care options, and/or coordinating referrals to appropriate services based on medical necessity.
Providence Health and Services
$52.26 - $81.13
Seattle, WA
It is comprised of eight hospital campuses (Ballard, Edmonds, Everett, Centralia, Cherry Hill (Seattle), First Hill (Seattle), Issaquah and Olympia); emergency rooms and specialty centers in Redmond (East King County) and the Mill Creek area in Everett; and Providence Swedish Medical Group, a network of 190+ primary care and specialty care locations throughout the Puget Sound. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Incredible Health
$59030 - $77630
Macon, GA
Employer features: Academic medical center, Adoption Assistance, Best Places to Work recognition, Career Advance Program, Community hospital, Disability Insurance, Family Care Benefits, FSA, Health Insurance, Level 1 trauma center, Level 2 trauma center, Level 4 trauma center, Life Insurance, Magnet recognized, Medical, Offers sign on bonus, PTO, Retirement Plan, Teaching Hospital, Tuition Assistance, U.S. News best hospital . Hospitals on Incredible Health are actively hiring and accepting applications in the Macon, GA area for the following position: Registered Nurse - Utilization Review.
Christus Health
Irving, TX
Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services.
Providence Health and Services
$43.29 - $76.06
Jber, AK
Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, outreach programs, and hospice and home care. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Williamson Health
Murfreesboro, TN
The flagship facility, Williamson Medical Center, which recently opened its new Boyer-Bryan West Tower, offers extensive women's services, state-of-the-art cardiology services, advanced surgical technologies, an award-winning obstetrics and NICU, leading-edge orthopaedics, outpatient imaging services, and distinct comprehensive emergency and inpatient services for both adult and pediatric patients. Timely reviews patients within 24 hours or next business day after admission and at a minimum of every 2 days thereafter for continued stay, applying appropriate criteria (Interqual®) and facilitating reimbursement for services with third payer parties, obtaining and entering authorization number/approval status and notes in Meditech.
GetMed Staffing
$2180.28
Everett, WA
Traveling with GetMed Staffing offers the unique opportunity to gain diverse experiences, both personally and professionally. GetMed Staffing is searching for a strong Utilization Review RN to assist our traveler-friendly client.
Prime Staffing
$2307.2
Washington, DC
The nurse collaborates with providers, insurance companies, and case managers to ensure compliance with coverage guidelines and supports optimal patient outcomes while managing healthcare costs. Description: The Utilization Review RN is responsible for reviewing medical records to determine the appropriateness and medical necessity of hospital admissions and continued stays.
St. Luke's University Health Network
Allentown, PA
Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The RN DRG Downgrades Appeals Review Specialist is responsible for the retrospective clinical review and defense of inpatient DRG downgrades, clinical validation denials, and medical necessity determinations issued by governmental and commercial payers.
Prime Staffing
$2605.2
Orange, CA
The nurse collaborates with providers, insurance companies, and case managers to ensure compliance with coverage guidelines and supports optimal patient outcomes while managing healthcare costs. Description: The Utilization Review RN is responsible for reviewing medical records to determine the appropriateness and medical necessity of hospital admissions and continued stays.
CHRISTUS Health
Irving, TX
Outreach to TOC patients should focus on medication reconciliation/adherence, self-management, use of personal health records, follow-up with PCPs/Specialists, and review of indicators that a patient’s condition is worsening and how to respond. Promotes a positive work environment by displaying a caring, sensitive approach to others, as evidenced by listening, understanding, and responding to the needs of patients, colleagues, and supervisors.
Providence Health and Services
$44.16 - $77.58
Chugiak, AK
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The goal of the Inpatient Care Management RN is to ensure the use of appropriate healthcare resources throughout the continuum, so that the care provided is the right care, at the right time, in the right setting.
Kinetic Personnel Group
Ontario, CA
Requirements: Three (3) or more years in healthcare administration in the areas of Utilization Management, Care Management, Quality Improvement or Quality Assurance, where medical record review, preferably in an HMO or managed care setting, is required. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.
Pyramid Consulting, Inc
$75 - $85
Santa Clara, CA
Utilization Management:-Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge. By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners.
Spectraforce Technologies Inc
Atlanta, GA
Configuration support will be for both pharmacy and medical criteria and will require good creative problem solving skills to ensure appropriate setup to meet client needs and maximum operation efficiency. Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers.
Valley Manor Care Center
$37.45 - $44.95
Eckert, CO
While providing care to our patients, we want our staff to feel cared for and love their work while maintaining a work-life balance, so offering employees paid-time off benefits is a part of our comprehensive benefits package Our diverse and involved staff members are supported by the commitment to maintain relationships of functional trust with every team member, to always practice solutions-focused problem solving, and to continually affirm each team member’s contribution to the quality of our work. Provides Leadership and Direction on Assigned UnitRole models positive communication skills with NA/R’s, C.N.A.’s, STNAs, TMA’s (if applicable), interdisciplinary team, supervisory and management team, customers, residents and families.
Convergence Medical Staffing
$2286
Kinston, NC
Job Nurse - Utilization Review @ UNC Health Lenoir, City: Kinston, State: North Carolina, Estimated Start , Shift:5 x 8 Hour Day Shift, 07:00:00-15:00:00, 8.00-5, Length of Contract (Days) : 91, Estimated Gross Pay: 0.00. The Convergence Medical Staffing Mobile App enables our travelers to search for jobs as well as upload and manage needed information quickly and simply, thus allowing for speedy submittal to facilities.
MRG Exams
$120000 - $130000
Yuba City, CA
This role involves conducting focused, in-person physical exams and reviewing medical records electronically to complete the required documentation for the VA. We are seeking a dedicated Nurse Practitioner (NP) or Physician Assistant (PA) to join our team in performing medical assessments for U.S. Veterans as part of the VA's disability benefits process.
MRG Exams
Forest, VA
This role involves conducting focused, in-person physical exams and reviewing medical records electronically to complete the required documentation for the VA. We are seeking a dedicated Nurse Practitioner (NP) or Physician Assistant (PA) to join our team in performing medical assessments for U.S. Veterans as part of the VA's disability benefits process.
MRG Exams
Bemidji, MN
This role involves conducting focused, in-person physical exams and reviewing medical records electronically to complete the required documentation for the VA. We are seeking a dedicated Nurse Practitioner (NP) or Physician Assistant (PA) to join our team in performing medical assessments for U.S. Veterans as part of the VA's disability benefits process.
GQR Healthcare
$1768 - $1863
Washington, DC
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$1860 - $1955
Alamogordo, NM
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2352 - $2447
Anchorage, AK
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$1315 - $1410
Windom, MN
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2662 - $2757
Oakland, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2557 - $2652
Burlingame, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2511 - $2606
Falls Church, VA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2065 - $2160
Seattle, WA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2007 - $2102
Detroit, MI
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2150 - $2245
Portland, OR
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2110 - $2205
Santa Barbara, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2500 - $2595
Falls Church, VA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
MRG Exams
Williamsport, PA
This role involves conducting focused, in-person physical exams and reviewing medical records electronically to complete the required documentation for the VA. We are seeking a dedicated Nurse Practitioner (NP) or Physician Assistant (PA) to join our team in performing medical assessments for U.S. Veterans as part of the VA's disability benefits process.
TechLink Systems, Inc.
Everett, WA
Guaranteed Hours: 72 hours per 2 week period. Total Weekly Hours: 40 Start date: ASAP.
Lancesoft Inc
$2230
Apple Valley, CA
Years of experience REQ: 3-year acute medical Care Manager/UM experience performing utilization review in a hospital setting (not health plan/medical group). • First-timers accepted: Seasoned traveler is required Hardstop.
Matrix Medical Network
$1800 - $11500
Caret, VA
Matrix Medical Network pioneered the first national in-home clinical network, and today we’re an independent provider of comprehensive health assessments serving people across the nation. Additional Licensure – Should business need exist; we will support you in obtaining additional state licensure and credentialing in neighboring states – or others you may want to visit while completing health assessments.
Matrix Medical Network
$1800 - $11500
Warren, TX
Matrix Medical Network pioneered the first national in-home clinical network, and today we’re an independent provider of comprehensive health assessments serving people across the nation. Additional Licensure – Should business need exist; we will support you in obtaining additional state licensure and credentialing in neighboring states – or others you may want to visit while completing health assessments.
Matrix Medical Network
$1800 - $11500
Timberville, VA
Matrix Medical Network pioneered the first national in-home clinical network, and today we’re an independent provider of comprehensive health assessments serving people across the nation. Additional Licensure – Should business need exist; we will support you in obtaining additional state licensure and credentialing in neighboring states – or others you may want to visit while completing health assessments.
Matrix Medical Network
$105500 - $168400
Glen Allen, VA
Additional Licensure – Should business need exist; we will support you in obtaining additional state licensure and credentialing in neighboring states – or others you may want to visit while completing health assessments. Matrix Medical Network pioneered the first national in-home clinical network, and today we’re an independent provider of comprehensive health assessments serving people across the nation.
Matrix Medical Network
$95500 - $158400
Chesapeake, VA
Matrix Medical Network pioneered the first national in-home clinical network, and today we’re an independent provider of comprehensive health assessments serving people across the nation. Additional Licensure – Should business need exist; we will support you in obtaining additional state licensure and credentialing in neighboring states – or others you may want to visit while completing health assessments.
Matrix Medical Network
$95500 - $158400
Midlothian, VA
Matrix Medical Network pioneered the first national in-home clinical network, and today we’re an independent provider of comprehensive health assessments serving people across the nation. Additional Licensure – Should business need exist; we will support you in obtaining additional state licensure and credentialing in neighboring states – or others you may want to visit while completing health assessments.
Matrix Medical Network
$105500 - $168400
Richmond, VA
Additional Licensure – Should business need exist; we will support you in obtaining additional state licensure and credentialing in neighboring states – or others you may want to visit while completing health assessments. Matrix Medical Network pioneered the first national in-home clinical network, and today we’re an independent provider of comprehensive health assessments serving people across the nation.
GQR Healthcare
$1931 - $2026
Greensboro, NC
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
Maplewood Brewster LLC
Hyannis, MA
Summary: The Resident Services Nurse (Registered Nurse) is responsible for assisting the Resident Services Director with the overall implementation, delivery, and coordination of Resident Care Services at the Community. Supervise Resident Services Department associates, including C.N.A.’s (Resident Services Assistants).
Maplewood Brewster LLC
Marstons Mills, MA
Summary: The Resident Services Nurse (Registered Nurse) is responsible for assisting the Resident Services Director with the overall implementation, delivery, and coordination of Resident Care Services at the Community. Supervise Resident Services Department associates, including C.N.A.’s (Resident Services Assistants).
Partners in Care Foundation In
$80000 - $95000
San Fernando, CA
The Clinical Consultant RN or Licensed Clinical Social Worker, LCSW partners with Care Managers, Behavioral Health clinicians, Primary Care Providers, hospitals, Managed Care Plans, and community-based organizations to ensure high-quality, whole-person, and evidence-based care. This role supports interdisciplinary care teams serving individuals with complex medical, behavioral health, and social needs, including people experiencing homelessness, serious mental illness, substance use disorders, chronic disease, and socioeconomic instability.
GQR Healthcare
Sundance, WY
Role Overview - RN responsible for case management across acute care, swing bed, and outpatient services. Focus on discharge planning, utilization review, care coordination, and CMS compliance.