PRIDE Health is seeking a travel nurse RN Utilization Review for a travel nursing job in New York, New York. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 10/26/2026 Duration: 7 weeks 40 hou...

American Traveler is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Fort Myers, Florida. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 10/26/2026 Durat...

HonorVet Technologies is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in New York, New York. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 10/26/2026 Du...

How you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays... organizations, external reviews, and other payers. Communicate with physicians to schedule peer to peer reviews. Accurately report...

required for highly-complex and/or escalated reviews, and providing expert guidance to team members and partnering with the health care... and/or escalated reviews, and providing expert guidance to team members and partnering with the health care team, members...

Production Packers Marathon Staffing is hiring Production Packers to support a fast-paced production environment. If you enjoy hands-on work, take pride in quality, and want to be part of a team, we’d love to hear from you. Pack and prep...

Production Packers Marathon Staffing is hiring Production Packers to support a fast-paced production environment. If you enjoy hands-on work, take pride in quality, and want to be part of a team, we’d love to hear from you. Pack and prep...

Production Packers Marathon Staffing is hiring Production Packers to support a fast-paced production environment. If you enjoy hands-on work, take pride in quality, and want to be part of a team, we’d love to hear from you. Pack and prep...

Production Packers Marathon Staffing is hiring Production Packers to support a fast-paced production environment. If you enjoy hands-on work, take pride in quality, and want to be part of a team, we’d love to hear from you. Pack and prep...

but not limited to: 1. Completes initial reviews of patient records within 24–48 hours of admission: evaluate documentation... to evaluate medical necessity of the hospital care. 2. Conducts follow-up reviews of patients daily in accordance with payer...

. Responsibilities: Orchestrate cross-functional reviews with Medical, Regulatory, Legal, and Commercial stakeholders to ensure...

agreements. Reviews loan (or collateral) documents, handles file processing and works with external/internal clients and contacts...

: Conduct prospective, concurrent, and retrospective medical necessity reviews for admissions and service requests to ensure...

actions. 35% Receives, researches, reviews and analyzes professional and institutional claims using critical thinking...

and Clinical Health Act (HITECH). Performs desktop medical reviews. Attends annual security awareness, rules of conduct...) or Recovery Audit Contractor (RAC) appeals. Experience performing pre- and post-pay claims reviews, and utilization reviews may...

and software to conduct thorough medical record reviews in line with NCQA specifications, retrieval follow-up, and escalating...

clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy... appeals are completed thoroughly and on a timely basis. Interface with managed care organizations, external reviews...

, savings, appeal overturn rate, and reviews completed by staff to identify opportunities for process improvements. Meet...

. Performs Level I Medical Peer Reviews, documents summary of case review. Facilitates the referral of issues to the appropriate...

, quality reviews, and regulatory reporting activities. Required Qualifications 3+ years of healthcare data analysis, SIU...