Utilization Review Jobs

This full-time RN Case Manager role is based at an acute care academic medical center in Syracuse, New York, focusing on optimizing patient care transitions and resource utilization. The position involves conducting utilization reviews to determine appropriate care levels, coordinating discharge planning and post-acute care transitions, and documenting care coordination within the EPIC system. Key duties also include ensuring compliance with payer guidelines and collaborating with emergency department teams for rapid case management. The role is particularly appealing for nurses seeking professional growth within a premier academic setting, offering a structured Monday through Friday day shift schedule. Candidates must possess a current New York State RN license, BLS certification, and specific experience in pediatric acute care hospital case management.

This role serves as a Patient Care Coordinator within the Case Management team, focusing on optimizing patient outcomes through strategic care planning and utilization review. The position involves collaborating with physicians and multidisciplinary teams to develop comprehensive discharge plans, conduct daily utilization reviews, and ensure compliance with Medicare regulations and health plan benefits. Key responsibilities include monitoring care progression, identifying cost-effective protocols, and maintaining continuity of care across skilled nursing facilities and community services. The position offers the opportunity to work in a collaborative Labor/Management Partnership environment that values the nursing vision and continuous quality improvement. While the role is primarily administrative, it includes direct patient care duties to maintain clinical competency.

The role involves an Inpatient Registered Nurse Care Manager position at Providence Alaska Medical Center in Anchorage, focusing on coordinating comprehensive care for at-risk patients within an acute care setting. Key responsibilities include conducting patient assessments, developing care plans, managing resource utilization, overseeing discharge planning, and ensuring regulatory compliance. This position appeals to nurses seeking to work at the top of their scope with opportunities for broad clinical and operational growth in a supportive, patient-centered culture. The team values flexibility and teamwork, offering a meaningful environment to develop as a well-rounded leader. The position is full-time and on-site, providing a chance to serve a diverse community in an extraordinary Alaska setting.

This Nurse Case Manager role is based at a Level 2 trauma center in Grand Blanc, Michigan, supporting a team dedicated to optimizing patient care pathways. The position involves conducting comprehensive patient assessments, collaborating with providers to develop individualized care plans, and serving as the primary liaison between patients, families, and the medical team. Key responsibilities include monitoring patient progress, adjusting treatment strategies, and maintaining accurate electronic health records. The role appeals to nurses seeking a supportive environment with recognition as a Best Place to Work, offering opportunities for cross-training and tuition assistance. Flexible scheduling options include full-time, part-time, and per diem shifts, with benefits such as paid parental leave, retirement plans, and adoption assistance available to eligible staff.

This 13-week travel nursing role places a Registered Nurse as a Case Manager within a hospital-based Care Management team in Olympia, Washington. The position involves coordinating patient care, conducting needs assessments, and managing discharge planning for a diverse population ranging from neonates to geriatrics. Key responsibilities include performing utilization reviews, collaborating with interdisciplinary teams, ensuring regulatory compliance, and maintaining documentation using Epic EMR. The role offers the appeal of working with a supportive agency that prioritizes flexibility and administrative ease, allowing nurses to focus on patient outcomes. The schedule consists of day shifts with floating requirements, and the position is ideal for experienced nurses seeking a new location and professional growth.

The Home Health Clinical Manager role at CenterWell Home Health involves leading a team of clinicians to deliver compassionate, high-quality care in home settings. Reporting to the Branch Director, the Registered Nurse oversees clinical operations, reviews patient referrals, assigns staff, and ensures compliance with Medicare and payer standards. Key responsibilities include guiding clinical decision-making, managing documentation and audits, and participating in hiring and staff development. The position offers the appeal of working within a caring community focused on helping patients regain independence while supporting team growth. This full-time, onsite role requires a valid RN license, management experience, and reliable transportation for local travel.

The Home Health Clinical Manager role at CenterWell Home Health involves leading a team of clinicians to deliver compassionate, high-quality care in home settings. Key responsibilities include overseeing clinical operations, managing staff performance and training, ensuring regulatory compliance, and coordinating patient care plans with physicians and families. This position is based onsite and requires a valid Registered Nurse license with prior management experience. The role appeals to professionals seeking to make a meaningful impact by empowering patients to regain independence while working within a supportive, patient-centered culture that values whole-person wellness and professional growth.

This full-time Registered Nurse Clinical Manager role at CenterWell Home Health involves leading a team of clinicians to deliver compassionate, high-quality home care. The position requires overseeing clinical operations, managing patient admissions and care plans, and ensuring strict regulatory compliance and documentation quality. Key responsibilities include mentoring staff, coordinating with physicians and caregivers, and participating in quality improvement initiatives. The role is based onsite at a specific branch location and offers the opportunity to work within a caring community focused on helping patients regain independence. It appeals to professionals seeking a leadership position that combines clinical expertise with team development in a supportive, patient-centered environment.

The Home Health Clinical Manager role at CenterWell Home Health involves leading a team of clinicians to deliver compassionate, high-quality care in home settings. Reporting to the Branch Director, the Registered Nurse oversees clinical operations, reviews patient referrals, assigns staff, and ensures compliance with Medicare and payer standards. Key responsibilities include mentoring clinicians, managing documentation and audits, coordinating care with physicians, and participating in hiring and performance evaluations. The position offers the opportunity to make a meaningful impact by helping patients regain independence while working within a collaborative culture focused on whole-person wellness. This full-time, onsite role requires a valid RN license, management experience, and reliable transportation for local travel.

This full-time Registered Nurse Clinical Manager role at CenterWell Home Health involves leading a team of clinicians to deliver compassionate, high-quality home care. The position requires overseeing clinical operations, managing patient admissions and care plans, and ensuring strict regulatory compliance and documentation quality. Key responsibilities include mentoring staff, coordinating with physicians and caregivers, and driving quality improvement initiatives. The role is based onsite and offers the opportunity to make a meaningful impact by helping patients regain independence in a supportive, patient-centered culture. It is ideal for an experienced nurse seeking a leadership position within a dedicated healthcare community.

This full-time Registered Nurse Clinical Manager role at CenterWell Home Health leads a team of clinicians delivering compassionate home care to patients recovering from illness or managing chronic conditions. Reporting to the Branch Director, the position involves overseeing clinical operations, ensuring regulatory compliance, and managing staff hiring, training, and performance. Key responsibilities include reviewing patient referrals, assigning care plans, conducting audits, and coordinating with physicians to support patient outcomes. The role offers the appeal of working within a caring community focused on whole-person wellness and patient independence. While the position requires onsite office presence and reliable transportation for local travel, it provides opportunities for professional growth within a leading healthcare organization dedicated to personalized senior care.

This 13-week travel nursing role places a Registered Nurse as a Case Manager within a Washington hospital setting. The position focuses on coordinating medical care for high-risk patients, ensuring cost-effective treatment plans, and educating physicians on regulatory criteria such as InterQual and CMS standards. Key responsibilities include managing discharge planning, preventing service duplication, and collaborating with the healthcare team to deliver quality outcomes across diverse patient populations. The role appeals to professionals seeking rapid professional growth through exposure to varied clinical environments and patient demographics. It offers immediate start availability, comprehensive benefits including health coverage from day one, and the opportunity to build transferable adaptability skills while working in a dynamic healthcare setting.

This full-time Medical Case Manager role supports government and public sector clients within Sedgwick's Healthcare & Medical Services department. The position involves reviewing medical documentation, conducting virtual or on-site assessments, and developing individualized care strategies to facilitate recovery and return-to-work. Key responsibilities include collaborating with providers and claims adjusters to ensure appropriate care, educating stakeholders on treatment plans, and maintaining accurate case documentation. The role appeals to clinical professionals seeking a mission-driven environment where they can apply their expertise to improve public health outcomes. It offers a collaborative culture focused on professional growth, continuous learning, and the opportunity to make a meaningful impact on individuals and public programs.

This full-time Inpatient Registered Nurse Care Manager role operates within the acute care environment at Providence St. Peter Hospital in Olympia, Washington. The position focuses on delivering patient-centric care management for at-risk individuals, with key responsibilities including comprehensive care assessment, discharge planning, resource utilization review, and ensuring regulatory compliance. The role appeals to nurses seeking a collaborative culture built on mutual respect and whole-person care, offering opportunities for professional growth and career advancement within a large, inclusive healthcare organization. The position requires an active Washington nursing license and acute care experience, and it is an on-site role with multiple shift options available.

The Clinical Director role is a full-time position for a licensed PhD Psychologist based at the Graceville Correctional Facility in Florida. The incumbent reports to the health services administrator and oversees the facility's mental health program, ensuring compliance with state and federal correctional standards. Key responsibilities include supervising mental health professionals, developing quality assurance protocols, auditing patient records, and leading quality improvement initiatives. This position offers the opportunity to make a significant impact by providing expert psychological care to inmates while working within a structured team environment. The role includes comprehensive benefits such as health insurance, retirement matching, and paid time off, supporting a stable career in a mission-driven correctional healthcare setting.

This per diem, on-call day shift role involves serving as a Care Manager RN within the acute care setting at Providence St. Vincent Medical Center. The position focuses on guiding patients through the continuum of care by screening for post-acute needs, coordinating transitions, and developing care plans that meet regulatory standards. Key responsibilities include collaborating with the care team, providing patient education, and monitoring the effectiveness of ongoing care strategies. The role appeals to nurses seeking a supportive environment that values whole-person care and empowers staff voices. It offers the opportunity to work within a large, inclusive healthcare system known for its mission to serve vulnerable populations, fostering professional growth and a culture of mutual respect while maintaining an on-site presence in Portland.

This on-call pharmacist role supports the Longevity Scripts team at their Fort Myers location, focusing on long-term care pharmacy services. The position involves evaluating physician medication orders for safety and appropriateness, conducting drug utilization reviews to prevent adverse interactions, and recommending therapy changes to medical staff. Key responsibilities also include maintaining patient databases, reconciling controlled substance logs with inventory, and providing clinical expertise to internal and external healthcare partners. The role appeals to licensed pharmacists seeking flexible scheduling with rotating weekends and nights, requiring only one shift per month. It offers a dynamic environment for professionals with one to three years of long-term care experience and a Florida license to apply their clinical knowledge while honoring those who serve.

This per diem, on-call day shift role is a Registered Nurse Care Manager position within the Care Management department at Providence St. Vincent Medical Center. The role involves coordinating patient care in an acute setting by screening for post-acute needs, planning transitions, and collaborating with a continuum care team to ensure effective care delivery. Key responsibilities include developing care plans, providing patient education, and monitoring the ongoing effectiveness of treatment strategies. The position offers the appeal of working within a supportive, patient-focused culture that values whole-person care and professional growth. As an on-site role in Portland, Oregon, it allows nurses to contribute to a comprehensive healthcare system dedicated to serving vulnerable communities while maintaining flexibility through a per diem schedule.

This full-time Graduate Pharmacy Intern role is designed for recent PharmD graduates to transition into professional practice within CVS Health retail locations. The position involves applying academic knowledge to real-world pharmacy operations under the supervision of licensed pharmacists, with a focus on patient safety, accurate prescription fulfillment, and quality assurance. Key responsibilities include managing workflow across production and pickup stations, counseling patients, handling telephonic orders, and supporting immunization services where permitted. The role appeals to candidates seeking a structured 120-day training roadmap to prepare for pharmacist licensure and greater accountability. It offers a collaborative culture centered on continuous improvement and patient care, with opportunities for growth, flexible scheduling, and potential travel across district locations to meet business needs.

The Medical Director, Medical Management role at Highmark Inc. leads a physician team responsible for ensuring utilization management aligns with current clinical standards. Key duties include conducting electronic reviews of escalated cases to determine medical necessity, engaging in peer-to-peer discussions, and advising multidisciplinary teams on complex care scenarios. The position also involves developing clinical protocols and managing special projects to improve member care. This opportunity appeals to physicians seeking to impact population health within a collaborative environment that values critical thinking and professional growth. The role is primarily office-based with occasional travel up to 25 percent.

The Medical Director, Medical Management role at Highmark Inc. leads a physician team responsible for overseeing utilization management and ensuring clinical standards align with current regulations. Key duties include conducting electronic reviews of escalated cases to determine medical necessity, participating in multidisciplinary case management teams, and developing clinical protocols. The position offers the opportunity to influence care quality for members while working within a collaborative environment that values physician expertise. The role is primarily office-based with minimal travel requirements and supports professional growth through involvement in special projects and guideline development.

This full-time Case Manager RN role at Northwest Hospital focuses on coordinating inpatient discharge planning and optimizing care outcomes for patients with complex health needs. The position requires collaboration with clinical teams to ensure efficient service utilization and minimize payment denials while promoting patient wellness. Key responsibilities include developing intervention strategies, managing care transitions, and working within a rotating schedule that alternates between five and four eight-hour shifts. The opportunity is appealing due to the organization's commitment to community-centered care and a culture that encourages working at the top of one's license. The role offers significant professional growth through tuition reimbursement and specialized training in neonatal critical care leadership, alongside a supportive environment that values innovation and collaboration.

The RN Case Manager role supports patient care coordination within a hospital setting under the direction of the Director of Case Management. Key responsibilities include conducting comprehensive patient assessments, managing discharge planning, and addressing bed capacity issues in collaboration with bed management. The position also involves educating physicians and team members on utilization review, admission appropriateness, and regulatory compliance. This role appeals to nurses seeking to impact care quality and efficiency through strategic coordination and transition management.

This part-time Staff Physical Therapist role involves evaluating and treating patients within a healthcare facility while collaborating with physicians, families, and the broader health team. Key responsibilities include conducting patient assessments within 24 hours of referral, developing and approving treatment plans, supervising physical therapy assistants and aides, and providing in-service training to facility staff. The position also requires maintaining accurate medical documentation and participating in discharge planning and care conferences. The role appeals to professionals seeking a collaborative environment where they can mentor junior staff and contribute to patient recovery outcomes. The position requires on-site presence and involves frequent physical activity such as standing, walking, and lifting.

The Human Resource Manager leads the HR department to align staff policies and activities with the organization's mission and talent strategy. Key responsibilities include overseeing HR staff, managing the full recruitment lifecycle, mediating employment disputes, and ensuring compliance with labor laws and accreditation standards. The role also involves analyzing HR metrics to support strategic planning and administering employee benefits and performance reviews. This position offers an opportunity to shape a positive, respectful workplace culture while driving organizational growth through effective talent management and policy development.