Utilization Review Jobs

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.

Centinela Hospital Medical Center is hiring an RN Case Manager to coordinate inpatient care, perform concurrent review for medical necessity, and support cost-effective, high-quality patient outcomes.

Experienced RN/LPN with utilization review and healthcare operations experience needed to lead Dane Street's remote regional operations team, drive profitability, and ensure quality and scheduling performance.

Cleveland Clinic Tradition Hospital is hiring a Manager of Care Management to oversee utilization review, discharge planning, and a multidisciplinary care management team to improve patient outcomes and transitions of care.

Emory Healthcare is hiring an MSW-level Social Work Care Manager (PRN) in Atlanta to lead inpatient discharge planning, coordinate post-acute services, and advocate for patients across clinical and payer stakeholders.

Presbyterian Healthcare Services seeks a detail-oriented Health Services Assistant in Albuquerque to manage prior authorizations, claims-related documentation, provider coordination, and data entry to support patient care and clinical operations.

CVS Health is hiring Graduate Pharmacy Interns in Boston to support retail pharmacy operations, grow clinical skills, and prepare for pharmacist licensure through a structured post-graduate training program.

Cognizant is hiring a remote Claims Processor to adjudicate professional and institutional medical claims accurately using Facets and standard coding guidelines.

A Clinical Liaison role at Lehigh Valley Health Network responsible for referral screening, insurance verification/authorization, bed management and coordination of admissions for the inpatient rehabilitation facility.

Experienced, Board-Certified Orthopedic Spine Surgeons with active Texas licenses are needed to perform independent record reviews, counter-affidavits, and expert witness services on a per-case 1099 contract basis.

CVS Health is hiring a remote Utilization Management Nurse Consultant (Behavioral Health) to conduct clinical reviews, manage prior authorizations, and apply evidence-based criteria for behavioral health and substance abuse services.

Experienced utilization review professional needed to manage authorizations, appeals, audit tracking, and serve as an SME for the UR team at Saint Mary of Nazareth in Chicago.

Select Medical in Mount Clemens is seeking an experienced RN/RT/SW Case Manager to manage utilization review, discharge planning and multidisciplinary coordination for complex, post-ICU patients.

Presbyterian Healthcare Services is hiring a Health Services Assistant in Albuquerque to manage prior authorizations, medical records coordination, claims research, and provider communications.

UMMC seeks an experienced RN Care Coordinator to deliver pediatric forensic care coordination, patient education, and evidence-based chronic disease management for children and families.

Dane Street seeks board-certified Emergency Medicine physicians licensed in Texas to perform remote, per-case medical-legal reviews and counter-affidavits with occasional deposition/trial duties.

Experienced, board-certified Internal Medicine physicians with an active Texas license are needed to perform independent medical record reviews and counter-affidavits for legal clients on a flexible contract basis.

Dane Street is recruiting Texas-licensed, board-certified Orthopedic Surgeons to provide contract physician-review and counter-affidavit/expert witness services for legal clients.

Experienced licensed psychologist needed to perform medical necessity reviews, appeals, and peer-to-peer consultations for Telligen’s managed care contracts on a part-time 1099 basis.

Dental Insurance

Disability Insurance

Vision Insurance

Equity

Paid Time-Off

Medical Insurance

Mental Health Resources

Paid Holidays

Company Retreats

Hims & Hers is hiring a Staff Pharmacist to ensure safe, accurate dispensing and outstanding patient care at its New Albany, OH pharmacy, working a Wed–Sat schedule.

UMMS is hiring a PRN Clinical Documentation Specialist in Towson to ensure complete, accurate inpatient documentation that supports correct ICD-10 coding and high-quality clinical data.

Sutter Health is hiring a Physician Advisor to lead utilization review, support clinical documentation improvement, and guide level-of-care decisions at its Sacramento facility.

Seeking a detail-oriented Medical Chart Auditor with behavioral health expertise to ensure documentation accuracy and regulatory compliance across SUD, mental health, and eating disorder programs.

Humana seeks a licensed Texas DDS/DMD with clinical and utilization review experience to serve as Dental Director, providing clinical oversight of claims, appeals, policy development, and quality initiatives for its Texas member population.

Prime Healthcare seeks an organized Utilization Review Tech II to coordinate utilization review and appeals processes, manage payer communications, and maintain audit and denial tracking for our Ontario corporate/facility teams.

Clinical Pharmacist (Utilization Management) to support PBM clinical operations by reviewing utilization requests, creating policy, and coordinating with prescribers and internal teams to drive safe, cost-effective medication access.

Centene seeks a board-certified MD/DO to serve as a Remote Medical Director for Georgia, providing clinical leadership for utilization management, quality improvement, and credentialing.

Mass General Brigham seeks an RN Supervisor, Utilization Management to lead and coach a clinical team conducting inpatient and outpatient utilization reviews while driving quality, productivity, and system improvements.

Experienced LVN/RN with utilization review background needed to perform clinical reviews, determine medical necessity, and collaborate with providers and case teams in a remote Utilization Management Nurse Reviewer role at Dane Street.

Dental Insurance

Disability Insurance

Vision Insurance

Equity

Paid Time-Off

Medical Insurance

Mental Health Resources

Paid Holidays

Company Retreats

Hims & Hers seeks an experienced Staff Pharmacist in Gilbert to oversee night-shift dispensing, patient counseling, regulatory compliance, and technician supervision.

Prime Healthcare is hiring a CDS Trainee to conduct clinical documentation reviews and partner with care teams to optimize documentation for quality and reimbursement.

Lead and grow ARH's regional Utilization Review program by directing staff, ensuring compliance with regulatory standards, and optimizing patient care and resource utilization.

Experienced nursing administrator needed to lead Admissions, Intake and Outreach at Calvary Hospital, managing referrals, reimbursement, quality, and departmental operations.

Prime Healthcare Saint Mary of Nazareth is hiring an RN Assessment (MDS) Coordinator to lead resident comprehensive assessments, manage MDS/RUGs reporting, and coordinate the interdisciplinary care team.

Experienced board-certified Diagnostic Radiology physicians are needed to provide objective medical necessity reviews and advisory opinions for IMEs and utilization review on a flexible, per-case basis.

Dane Street is hiring a board-certified Hematology/Oncology physician to perform IME reviews and advisory services, providing objective, evidence-based determinations for insurance appeals and claims reviews.

Experienced, board-certified cardiologist needed to perform independent medical exams and medical necessity reviews on a flexible, remote contract basis.

Serve as an RN Case Manager overseeing utilization review and discharge planning at a premier academic medical center in Syracuse, NY.

Northwestern Medicine is hiring a PRN Utilization Reviewer to manage utilization review activities, insurance communications, and appeals for behavioral health patients in a remote capacity.

Experienced, board-certified MD/DO physicians are sought to serve as remote Medical Directors providing utilization management, clinical quality oversight, and provider collaboration for Centene's member populations.

Prime Healthcare is hiring a Bed Control Coordinator II in Lynwood to coordinate patient flow, perform utilization review, and manage insurance verifications to support timely, efficient care transitions.

ThedaCare is hiring an RN Care Manager to lead care coordination and transition planning across clinic, home, and community settings for patients in the Appleton region.

Lead Dane Street’s Group Health Division operations to improve client metrics, grow the business, and manage a team of Utilization Management nurses while owning divisional P&L.

Work remotely as a Medical Coder for a mission-driven team, applying ICD-10, CPT, HCPCS and PCS coding across settings while supporting QA, utilization review, and coding validation.

Experienced nurses are sought to manage utilization reviews and prior authorizations remotely for Presbyterian Healthcare Services, ensuring clinical appropriateness, timely authorizations, and quality audit oversight for Albuquerque-area members.

Garden Grove Hospital Medical Center is hiring a Medical Review Coordinator to perform clinical record reviews and coordinate utilization review and case management to ensure appropriate, compliant patient care and documentation.

Experienced RN Case Manager needed to lead utilization management and care coordination at Chino Valley Medical Center, ensuring medical necessity, efficient resource use, and quality patient outcomes.

Prime Healthcare Hospice seeks an experienced Field Nurse Case Manager to manage hospice admissions, coordinate care across providers, and ensure clinically appropriate, cost-effective outcomes.