Utilization Review Jobs

Innovaccer seeks an experienced oncology RN to lead utilization management reviews and refine AI-driven prior authorization workflows for improved accuracy and payer alignment.

University of Maryland Upper Chesapeake Health is hiring a Utilization Review Nurse (PRN) to conduct utilization reviews, ensure compliance, and work with care teams to optimize patient care and reimbursement.

Aurora Charter Oak Hospital is hiring a licensed California LVN/LPT as a Utilization Review Specialist to manage concurrent authorizations and support medically appropriate behavioral health care.

Centinela Hospital Medical Center is hiring a CDS Trainee to conduct concurrent and retrospective clinical documentation reviews and collaborate with clinical teams to ensure accurate inpatient documentation and compliance.

Lead clinical operations for CenterWell Home Health's Danville location as an experienced Registered Nurse responsible for patient care oversight, staff supervision, and regulatory compliance.

Provide clinical utilization review and care coordination for underserved patient populations as a Utilization Management Registered Nurse in Fort Lauderdale.

Emory Healthcare is looking for an experienced RN Care Manager to coordinate care for clinically complex patients, manage utilization review, and facilitate timely, cost-effective discharges.

Experienced acute-care RN needed to serve as a flexible Case Manager coordinating care, managing length of stay, and facilitating safe discharges across the Northwestern Medicine system.

Experienced RN or LPN/LVN needed to perform utilization review and clinical case assessments for HealthHelp’s specialty benefits management team in Houston, ensuring compliance and quality-driven care decisions.

Atrium Health Union is hiring an RN Care Manager (PRN days) to provide case management, care coordination, and documentation for patients across multiple care settings.

Dane Street is hiring Board-Certified Forensic Pathologists to perform remote disability peer reviews as independent contractor physician advisors, providing expert, evidence-based case assessments on a flexible, per-case schedule.

Provide clinical chart review and utilization management support at Saint Mary’s Regional Medical Center, ensuring appropriate criteria for admission and continued treatment while coordinating with clinical teams and payers.

OhioHealth seeks an experienced RN Care Manager to coordinate patient-centered care, apply evidence-based interventions, and collaborate across the care continuum at Riverside Methodist Hospital.

Peraton's SafeGuard Services seeks a seasoned Medical Review Manager (RN) to lead and develop a nursing medical-review team focused on detecting and referring Medicare and Medicaid fraud, waste, and abuse.

Provide remote, per-case independent medical necessity reviews in Radiation Oncology for a national IRO, working as a flexible 1099 contractor with a caseload you control.

Experienced RN (Utilization Management) needed to perform clinical reviews and care coordination at Vandenberg Space Force Base, ensuring quality, compliance, and cost-effective care.

Dane Street seeks Board Certified Pulmonary physicians with an active Washington license to perform telework medical necessity reviews as independent contractors on a flexible, per-case basis.

Provide objective, evidence-based utilization reviews for Dane Street as a remote, board-certified dental specialist with an active New York license.

Support clinical review workflows at Telligen by coordinating medical information, communicating review decisions, and ensuring data integrity in a hybrid in-office role.

Highmark is hiring a Remote Medical Case Manager (PA-licensed) to coordinate care, develop individualized plans, and manage complex medical and psychosocial cases for Pennsylvania members.

UChicago Medicine Ingalls is hiring a full-time onsite Utilization Management Case Manager (RN) to lead utilization reviews, coordinate care across teams and payers, and support clinical and operational outcomes at its Harvey campus.

Dane Street seeks board-certified PM&R and Pain Management physicians to serve as independent contract reviewers providing telework disability review opinions.

Northwestern Medicine is hiring a Charge Nurse (RN) to lead clinical care and operations for the Oncology Infusion unit on full-time day shifts at the Oakbrook location.

Dane Street is recruiting board-certified Interventional and Diagnostic Radiologists to perform remote, per-case medical necessity reviews and appeal determinations on a flexible contract basis.

Experienced RN with utilization management and prior authorization expertise needed to validate and improve AI-driven prior authorization workflows at Innovaccer.

Provide inpatient rehabilitation case management (RN or LMSW) on a per-diem basis, coordinating care, discharge planning, and utilization management for complex rehab patients at Ochsner Rehabilitation Hospital.

An experienced RN is sought for the Dialysis Care Coordinator role at UVM Medical Center to lead multidisciplinary dialysis care and coordinate services for a defined patient population.

Dane Street is hiring Board-Certified Plastic Surgeons licensed in Louisiana to perform flexible, remote utilization reviews on a contract basis, paid per case.

Lead the case management team at Select Specialty Hospital in Madison, directing utilization review, discharge planning, payer coordination, and staff development for medically complex patients.

Dane Street is recruiting NY-licensed, Board-Certified Occupational Medicine physicians to perform flexible, remote utilization reviews and produce guideline-based decisions on a per-case contract basis.