CrawlJobs Logo

Utilization Review Nurse-RN

personifyhealth.com Logo

Personify Health

Location Icon

Location:
United States

Category Icon
Category:
Nursing

Job Type Icon

Contract Type:
Not provided

Salary Icon

Salary:

30.00 - 38.00 USD / Hour
Save Job
Save Icon
Apply Position

Job Description:

The Utilization Review Nurse will provide professional assessments and review for the medical necessity of treatment requests and plans. The standard work schedule is Monday through Friday, 8:00 AM–5:00 PM Pacific Time, with rotating weekend coverage required.

Job Responsibility:

  • Provide professional assessment and review for the medical necessity of treatment requests and plans
  • Provide first level review for all outpatient and ancillary pre-certification requests for medical appropriateness
  • inpatient hospital stay including mental health, substance abuse, skilled nursing, and rehabilitation for medical necessity
  • and post claim or post service reviews
  • Work to the top of the RN license and ensure proper referral to medical director for denial authorizations through independent review organizations (IRO)
  • Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care
  • Refer requests that fall outside of established guidelines to advance review or senior care consultants
  • Process appeals for non-certification of services, complete non-certification letters when appropriate
  • Review plan document for benefit determinations
  • attempt to redirect providers and patients to PPO providers
  • Identify and refer potential cases to case management, wellness, chronic disease and Nurturing Together programs
  • Complete documentation for all reviews in appropriate documentation software
  • Utilize guidelines in appropriate hierarchy. Guidelines include MCG guidelines, internal medical policies, group specific policies, and NCCN
  • Ability to meet productivity, quality, and turnaround times daily
  • Ability to pass external audits to include URAC and NCQA
  • Maintain HIPPA compliance per company’s policy and procedures
  • Maintain confidentiality and minimum requirement rules
  • Complete all required yearly training per company’s expected time limit
  • Complete and pass all annual testing including IRRA at 90% or higher

Requirements:

  • Current RN license in the United States or U.S. territory
  • Associate’s degree or diploma (Nursing program) required
  • 1+ year clinical experience required
  • Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards
  • Ability to maintain regular, punctual attendance
  • Ability to sit for 6-8 hours
  • Constant use of computer keyboard and mouse
  • repetitive use of both hands
  • Occasional to frequent twisting of neck
  • occasional bending of neck and at waist
  • Must be able to remain in a stationary position 50% of the time
  • The person in this job needs to occasionally move about inside the office to access office machinery, filing cabinets and meeting facilities
  • Constantly operates a computer and other office productivity machinery, such as copy machine, computer printer, calculator, etc.
  • Frequently positions self to maintain files in file cabinets
  • Frequently moves boxes or equipment weighing up to 25 pounds
  • Must communicate information and ideas so others understand. Must be able to exchange accurate information in these situations
  • Must be able to observe details at close range
What we offer:
  • Competitive base salary and benefits effective day one
  • Comprehensive medical and dental through our own health solutions
  • Paid Time Off
  • Mental health support, retirement planning, and financial protection
  • Professional development with clear career progression and learning budgets

Additional Information:

Job Posted:
March 21, 2026

Employment Type:
Fulltime
Work Type:
Remote work
Icon
Personify Health - All Job Offers
Job Link Share:
Copy Link Icon
Facebook Icon Twitter Icon LinkedIn Icon

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Utilization Review Nurse-RN

Utilization Review Nurse-RN

The Utilization Review Nurse will provide professional assessments and review fo...
Location
Location
United States
Salary
Salary:
30.00 - 38.00 USD / Hour
personifyhealth.com Logo
Personify Health
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Current RN license in the United States or U.S. territory
  • Associate’s degree or diploma (Nursing program) required
  • 1+ year clinical experience required
  • Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards
  • Ability to maintain regular, punctual attendance
  • Ability to sit for 6-8 hours
  • Constant use of computer keyboard and mouse
  • repetitive use of both hands
  • Occasional to frequent twisting of neck
  • occasional bending of neck and at waist
Job Responsibility
Job Responsibility
  • Provide professional assessment and review for the medical necessity of treatment requests and plans
  • Provide first level review for all outpatient and ancillary pre-certification requests for medical appropriateness
  • inpatient hospital stay including mental health, substance abuse, skilled nursing, and rehabilitation for medical necessity
  • and post claim or post service reviews
  • Work to the top of the RN license and ensure proper referral to medical director for denial authorizations through independent review organizations (IRO)
  • Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care
  • Refer requests that fall outside of established guidelines to advance review or senior care consultants
  • Process appeals for non-certification of services, complete non-certification letters when appropriate
  • Review plan document for benefit determinations
  • attempt to redirect providers and patients to PPO providers
What we offer
What we offer
  • Competitive base salary and benefits effective day one
  • Comprehensive medical and dental through our own health solutions
  • Paid Time Off
  • Mental health support, retirement planning, and financial protection
  • Professional development with clear career progression and learning budgets
  • Mission-driven culture where diverse perspectives drive real impact on people's health
  • Fulltime
Read More
Arrow Right

Case Manager Nurse-RN

As a Case Manager RN, you will provide telephonic case management between provid...
Location
Location
United States
Salary
Salary:
36.00 - 38.00 USD / Hour
personifyhealth.com Logo
Personify Health
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Graduation from an accredited Registered Nursing (RN) program
  • Possession of a current California RN license
  • a multi-state license will also be required
  • Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience
  • Prior case management experience, emergency room, critical care background or other relevant clinical care experience pertinent to case management
  • Knowledge of medical claims and ICD-10, CPT, HCPCS coding
  • Ability to critically evaluate claims data and determine treatment plan, discharge planning experience
  • Ability to work independently making decisions and problem solving
  • Knowledge of community resources and alternate funding programs
  • Computer proficiency or working knowledge of Microsoft Office Suite
Job Responsibility
Job Responsibility
  • Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs
  • Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs
  • Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals
  • Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner
  • report measurable outcomes that record effectiveness of interventions
  • Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care
  • Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs
  • provide patient/family with emotional support and guidance
  • Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis
  • Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports
What we offer
What we offer
  • Competitive base salary and benefits effective day one
  • Comprehensive medical and dental through our own health solutions
  • Paid Time Off
  • Mental health support, retirement planning, and financial protection
  • Professional development with clear career progression and learning budgets
  • Mission-driven culture where diverse perspectives drive real impact on people's health
  • Fulltime
Read More
Arrow Right
New

Pharmacy Technician

We’re building a world of health around every individual — shaping a more connec...
Location
Location
United States , Drexel Hill
Salary
Salary:
Not provided
https://www.cvshealth.com/ Logo
CVS Health
Expiration Date
June 22, 2026
Flip Icon
Requirements
Requirements
  • Must comply with any state board of pharmacy requirements or laws governing the practice of pharmacy, which includes but is not limited to, age, education, and licensure/certification
  • If the state board of pharmacy does not address or mandate a minimum age requirement, must be at least 16 years of age
  • If the state board of pharmacy does not address or mandate a minimum educational requirement, must have a high school diploma or equivalent, or be actively enrolled in high school or high school equivalency program
  • State-level licensure and national certification requirements vary by state, click here to learn more
  • Regular and predictable attendance, including nights and weekends
  • Ability to complete required training within designated timeframe
  • Attention and Focus
  • Customer Service and Team Orientation
  • Communication Skills
  • Mathematical Reasoning
Job Responsibility
Job Responsibility
  • Living our purpose by following all company SOPs at each workstation to help our Pharmacists manage and improve patient health
  • Following pharmacy workflow procedures at each pharmacy workstation (i.e., production, pick-up, drive-thru, and drop-off) for safe and accurate prescription fulfillment
  • Contributing to positive patient experiences by showing empathy and genuine care
  • Completing basic inventory activities, as permitted by law, and as directed by the pharmacy leadership team
  • Contributing to a high-performing team, embracing a growth mindset, and being receptive to feedback
  • Remaining flexible for both scheduling and business needs, while contributing to a safe, inclusive, and engaging team dynamic
  • Understanding and complying with all relevant federal, state, and local laws, regulations, professional standards, and ethical principles
  • Delivering additional patient health care services (e.g., immunizations, point-of-care testing, and voluntarily staffing offsite clinics), where allowable by law and supported by required training and certification
  • Where permissible, the Pharmacy Technician may also support immunizations, which includes the following responsibilities: Completing additional licensure and training requirements, in compliance with state Board of Pharmacy regulations, to obtain Technician Immunizer status to support preparing and administering vaccines
  • Educating patients about the importance of vaccines and referring patients to the Pharmacist-on-duty for vaccination questions
What we offer
What we offer
  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • and other resources, based on eligibility
  • Fulltime
Read More
Arrow Right
New

Mri Technologist

MedPro Healthcare Staffing, a Joint Commission-certified staffing agency, is see...
Location
Location
United States , Springfield
Salary
Salary:
Not provided
medprostaffing.com Logo
MedPro Healthcare Staffing
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Completion of a two year approved School of Radiologic Technology
  • Valid state radiology registration as required by state law
  • Registry by the American Registry of Radiologic Technology.
Job Responsibility
Job Responsibility
  • MRI technologists utilize their knowledge of anatomy, physiology and the principles of MRI to safely and efficiently operate MRI scanners, assisting in the diagnosis of disease and injury.
  • Ensure the safety of patients, staff and visitors who come in contact with the powerful magnetic field of a MRI scanner.
  • Position patients and coils on a table that slides inside the MRI scanner.
  • Inject contrast media as required.
  • Set appropriate technical parameters, operate MRI scanners and related equipment, and observe image data on computer monitors during scans.
  • Be familiar with the differences from a normal image and an abnormal image.
  • Recognize and respond to life threatening situations.
  • Assure compliance with federal, state, and local technical and professional regulations and accepted practiced guidelines.
  • Delivers quality, cost effective patient care in a professional manner.
  • Works effectively to maintain an environment of excellence, which is patient focused, providing timely, compassionate, quality patient care.
What we offer
What we offer
  • Weekly pay and direct deposit
  • Full coverage of all credentialing fees
  • Private housing or housing allowance
  • Group Health insurance for you and your family
  • Company-paid life and disability insurance
  • Travel reimbursement
  • 401(k) matching
  • Unlimited Referral Bonuses up to $1,000
  • Fulltime
Read More
Arrow Right
New

Pharmacy Technician

We're building a world of health around every individual — shaping a more connec...
Location
Location
United States , Oakville
Salary
Salary:
18.94 - 28.94 USD / Hour
https://www.cvshealth.com/ Logo
CVS Health
Expiration Date
June 23, 2026
Flip Icon
Requirements
Requirements
  • Must be at least 16 years of age
  • Licensure requirements vary by state
  • Attention and Focus
  • Customer Service Orientation
  • Communication Skills
  • Mathematical Reasoning
  • Problem Resolution
  • Physical Demands
  • Visual Acuity
  • High School diploma or equivalent preferred but not required.
Job Responsibility
Job Responsibility
  • manage all assigned pharmacy workstations and tasks to support the team's ability to promptly, safely and accurately fill patient prescriptions
  • provide caring service that exceeds customer expectations
What we offer
What we offer
  • dental
  • vision
  • wellness resources
  • employee discounts
  • access to certain voluntary benefits
  • Parttime
Read More
Arrow Right
New

Cath Lab Registered Nurse

MedPro Healthcare Staffing, a Joint Commission-certified staffing agency, is see...
Location
Location
United States , Denville
Salary
Salary:
Not provided
medprostaffing.com Logo
MedPro Healthcare Staffing
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Active RN License
  • Degree from accredited nursing program
  • BLS & ACLS Certifications
  • Eighteen months of recent experience in an Acute Care Cath Lab setting
Job Responsibility
Job Responsibility
  • The Cardiac Cath Lab RN performs angioplasties, implants pacemakers and diagnoses cardiac conditions with an invasive catheterization procedure
  • Administer care for heart disease and heart attack patients by obtaining visual diagnostics of the arteries of the heart
  • Identify blockages, assisting the physician during procedures, and monitoring the patient’s status at other times
  • Administer interventional procedures like cardiac catheterizations, angioplasties, pacemaker and/or defibrillator implantation, and related interventional or diagnostic procedures
What we offer
What we offer
  • Weekly pay and direct deposit
  • Full coverage of all credentialing fees
  • Private housing or housing allowance
  • Group Health insurance for you and your family
  • Company-paid life and disability insurance
  • Travel reimbursement
  • 401(k) matching
  • Unlimited Referral Bonuses up to $1,000
Read More
Arrow Right
New

Pharmacy Technician

We’re building a world of health around every individual — shaping a more connec...
Location
Location
United States , Tipp City
Salary
Salary:
17.00 USD / Hour
https://www.cvshealth.com/ Logo
CVS Health
Expiration Date
July 25, 2026
Flip Icon
Requirements
Requirements
  • Must comply with any state board of pharmacy requirements or laws governing the practice of pharmacy, which includes but is not limited to, age, education, and licensure/certification
  • If the state board of pharmacy does not address or mandate a minimum age requirement, must be at least 16 years of age
  • If the state board of pharmacy does not address or mandate a minimum educational requirement, must have a high school diploma or equivalent, or be actively enrolled in high school or high school equivalency program
  • State-level licensure and national certification requirements vary by state, click here to learn more
  • Regular and predictable attendance, including nights and weekends
  • Ability to complete required training within designated timeframe
  • Attention and Focus: Ability to concentrate on a task over a period of time
  • Ability to pivot quickly from one task to another to meet patient and business needs
  • Ability to confirm prescription information and label accuracy, ensuring patient safety
  • Customer Service and Team Orientation: Actively look for ways to help people, and do so in a friendly manner
Job Responsibility
Job Responsibility
  • Living our purpose by following all company SOPs at each workstation to help our Pharmacists manage and improve patient health
  • Following pharmacy workflow procedures at each pharmacy workstation (i.e., production, pick-up, drive-thru, and drop-off) for safe and accurate prescription fulfillment
  • Contributing to positive patient experiences by showing empathy and genuine care: creating heartfelt and personalized moments while serving patients at pick-up, drive-thru, and over the phone
  • keeping patients healthy by offering immunizations and other services at the register and over the phone
  • and demonstrating compassionate care by solving or escalating patient problems
  • Completing basic inventory activities, as permitted by law, and as directed by the pharmacy leadership team, such as accurately putting away medication deliveries and completing cycle counts, returns-to-stocks, waiting bin inventories, etc.
  • Contributing to a high-performing team, embracing a growth mindset, and being receptive to feedback
  • actively seeking opportunities to expand clinical and technical knowledge needed to better assist patients
  • Remaining flexible for both scheduling and business needs, while contributing to a safe, inclusive, and engaging team dynamic
  • voluntarily traveling to stores in the market to work shifts as needed by the business
What we offer
What we offer
  • Dental
  • Vision
  • Wellness resources
  • Employee discounts
  • Access to certain voluntary benefits
  • Parttime
Read More
Arrow Right
New

Training Engineer

Unox, a market leader in the production of high-end ovens and certified as a Gre...
Location
Location
Italy , Cadoneghe
Salary
Salary:
Not provided
unox.com Logo
UNOX
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor’s or Master’s degree in Engineering
  • Excellent proficiency in English, and French or German
  • Willingness to travel internationally to visit subsidiaries and support partners, at least for one week per month
  • Entry-Level (<2 years)
Job Responsibility
Job Responsibility
  • Deliver continuous technical training, both remotely and in-person, to the network of technical support partners
  • Promote and maintain best practices related to the Service Academy
  • Oversee the training of Unox SpA internal and branch personnel, ensuring alignment with corporate standards
  • Create technical documentation and training materials for Unox products
  • Collaborate with design teams during product development, identifying key issues and proposing innovative solutions
What we offer
What we offer
  • Flexible Working Hours
  • Work-Life balance initiatives
  • Paid time off & overtime
  • Company canteen
  • Personal and family welfare
  • Health insurance & welfare programs
  • Pension & retirement plans
  • Mentorship & coaching
  • Career growth & training programs
  • Diversity & inclusion policies
  • Fulltime
Read More
Arrow Right