Utilization Review Nurse Jobs in the United States
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.
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.
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.
Providence Health and Services
$57.28 - $88.92
Santa Clarita, CA
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 amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
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.
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.
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.
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
$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.
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.
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
$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
$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
$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
$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
$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
$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.
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.
TechLink Systems, Inc.
Everett, WA
Guaranteed Hours: 72 hours per 2 week period. Total Weekly Hours: 40 Start date: ASAP.
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.
Job.com LLC
$2900 - $3000
Greenbrae, CA
We are seeking an experienced Registered Nurse (RN) – Utilization Review to join our healthcare team in an acute care hospital setting. Collaborate with physicians, case managers, and healthcare teams to optimize patient outcomes.
GQR Healthcare
$1357
Brownsville, TX
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
GQR Healthcare
$1524
Tallahassee, FL
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
GQR Healthcare
$1357
Round Rock, TX
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
GQR Healthcare
$1740
Fort Wayne, IN
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
GQR Healthcare
$1693
Asheville, NC
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
GQR Healthcare
$2088
Oklahoma City, OK
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
Mindlance Health
$40 - $45
Goldsboro, NC
Develops individualized care plans, conducts assessments, ensures service delivery without gaps, and collaborates with providers and caregivers to promote quality and cost-effective healthcare outcomes. Responsible for assessing, coordinating, and managing long-term services and supports (LTSS) for members with complex medical needs.
Mindlance Health
$40 - $45
Temple, TX
Develops individualized care plans, conducts assessments, ensures service delivery without gaps, and collaborates with providers and caregivers to promote quality and cost-effective healthcare outcomes. Responsible for assessing, coordinating, and managing long-term services and supports (LTSS) for members with complex medical needs.
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.
GQR Healthcare
Lebanon, NH
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
GQR Healthcare
$2134
San Pedro, CA
When you partner with us, you gain access to a wide range of benefits and support, including: Day 1 Benefits: Enjoy comprehensive healthcare coverage, including medical, dental, and vision plans, starting on your first day. Partnering with GQR means more than just finding your next job - it's about building a meaningful career with a team that truly supports your goals.
Nationwide Therapy Group
$1917
Torrance, CA
This includes offering exceptional pay packages along with these great benefits: Medical, dental, and vision insurance. NTG is committed to matching you to the right position and we pride ourselves on our commitment to our travelers.
Wayward Medical Staffing
$1736 - $2036
Jersey Shore, PA
Join the Wayward crew and experience travel nursing the way it was meant to be: rewarding, adventurous, and—dare we say it—fun. We’re Joint Commission Certified (fancy, huh?) and a 2023 Certified Great Place to Work.
ChristianaCare
$85862.4 - $137384
Newark, DE
Reviews the admission assessment and collaborates with primary nurse and other health care providers to ensure a multidisciplinary plan-of-care is in place to meet identified patient care needs and desired outcomes. ChristianaCare Hospital in Newark, DE, is seeking a Utilization Management Nurse (RN) with experience with insurance providers such as Aetna and Cigna, along with a background in an acute care hospital.
Wesley Medical Center
Wichita, KS
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. When you work as an RN for our Case Management Team, you are joining an elite team of nursing and healthcare professionals that are working together to care for our patients like family.
HCA HealthONE Presbyterian St. Luke's
$40.15 - $58.58
Denver, CO
Offering services across the continuum of care to meet patients’ total healthcare needs, HCA HealthONE includes seven acute care hospitals, a dedicated flagship pediatric hospital, a rehabilitation hospital, CareNow® urgent care clinics, mental health campuses, imaging and surgery centers, physician practices, home and hospice care, and AirLife Denver, which provides regional critical care air and ground transportation. Consistently among the Denver Business Journals’ list of top corporate philanthropists in the Denver-metro area, HCA HealthONE was named as one of the most community-minded organizations by The Civic 50 and contributed more than $1 million through cash and in-kind donations last year alone, along with more than $400M in federal, state and local taxes.
Memorial Healthcare System
Hollywood, FL
Assists the Case Management staff in resolving patient care issues for referred cases, provides physician education, and assists the hospital and medical staff in developing and promoting resource management goals and objectives. This includes, but not limited to: Makes decisions on referred individual patient cases regarding pre-admission authorization, medical necessity and services/setting, appropriateness of admission, and continuation stay.
A-Line Staffing Solutions LLC
$239000 - $259000
San Francisco, CA
This leadership role is responsible for overseeing care coordination, resource utilization, and safe patient transitions across the continuum of care while ensuring compliance, quality, and operational efficiency. Seeking an experienced Nurse Manager II to lead Utilization Management (UM) and Discharge Planning within a 240-bed acute care hospital in San Francisco.
Jobot
$105000 - $115000
Queens, NY
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. The Nurse Care Manager will work with the member and/or family member to maintain the most independent living situation possible; ensure consistent care along the entire health care continuum by assessing and closely monitoring member’s needs and status.
Del Sol Medical Center
Horizon City, TX
The Registered Nurse (RN) CM is responsible for promoting patient-centered care by coordinating the plan of care for the patient stay, managing the length of stay, ensuring appropriate resource management, and developing a safe appropriate discharge plan in collaboration with the multidisciplinary team. At HCA Healthcare, we are dedicated to ensuring nurses have necessary tools and resources to provide world-class patient care, advocating for the profession and helping to shape the future of nursing.".
Campbell County Health
Gillette, WY
Maintains required and concise documentation for patients including physical and functional limitations, psychosocial characteristics, plan of care to address post-hospital, treatment, and post treatment care needs, educational needs and involvement in planning for care of patient and family, family/ social support systems, financial, economic, and discharged needs. The RN Case Manager works to ensure the provision of quality health care along the continuum of care, decreases fragmentation, enhances the patient’s quality of life, efficiently utilizes patient care resources, maximizes cost containment opportunities, and improves successful post-hospitalization transition of care.
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.
HCA Florida Capital Hospital
Tallahassee, FL
Our facilities include a state-of-the-art Behavioral Health Center, Cancer Center, Chest Pain Center w/PCI-Resuscitation, Family Center, Heart & Vascular Center, Imaging Services, Neonatal Intensive Care Unit, Orthopedic/Spine Center, Physical Therapy Services, Rehabilitation Center, Stroke Center, Surgical Services, Surgical Weight Loss Center, Network-of-Care Affiliated Physician Practices, and much more. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
ChristianaCare
$41.28 - $66.05
Newark, DE
ChristianaCare includes an extensive network of primary care and outpatient services, home health care, urgent care centers, three hospitals (1,336 beds), a freestanding emergency department, a Level I trauma center, and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care and women’s health. Incredible Work/Life benefits including annual membership to care.com, access to backup care services for dependents through Care@Work, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets, and much more!