Top 21 Utilization review Jobs in Scranton, Pa

Utilization Review Representative
Wyoming Valley Behavioral Health —Kingston, PA
- $25 - $35 an hour
- Full-time
- Nursing
- RN License
- Mid-level
- Wellness program
- Disability insurance
Quick Apply
RN REGISTERED NURSE ASSESSMENT COORDINATOR
Elan Skilled Nursing —Scranton, PA
- From $42 an hour
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Dental insurance
Quick Apply
3d
Nurse Practitioner (PMHNP or FNP) - SUD & MH - Full-time
Banyan Treatment Centers —Laurel Run, PA
- Full-time
- Nursing
- Psychiatry
- Addiction Medicine
- Wellness program
- Paid holidays
Quick Apply
Physician Reviewer Multiple Specialties - TEXAS and NEW MEXICO
Federal Hearings And Appeals —Wilkes-Barre, PA
- Contract
- Remote
- Medicine
- Surgery
- Addiction Medicine
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Nurse Reviewer RN
Federal Hearings And Appeals —Wilkes-Barre, PA
- $67,500 - $95,000 a year
- Full-time
- RN License
- Mid-level
- Analysis skills
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Medical Social Worker, Home Health (Part-time)
ALLIED SERVICES —Clarks Summit, PA
- Part-time
- Master of Social Work
- Mid-level
- Driver's License
Clinical Liaison (Paramedic / Allied Health)
myLaurel —Lehigh, PA
- $100,000 - $105,000 a year
- Full-time
- Acute care
- Hospital
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
RN Clinical Liaision
myLaurel —Lehigh, PA
- $100,000 - $105,000 a year
- Full-time
- Acute care
- RN License
- Hospital
- Paid holidays
- Health insurance
Quick Apply
Licensed Clinician (LPC, LCSW, LMFT)
Provive Wellnes of Wayne —Scranton, PA
- Full-time
- LMFT
- Pass drug screening
- Licensed Clinical Social Worker
Quick Apply
5d
Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)
UT Health Science Center at San Antonio —United States
- Hospital
- Outpatient experience
- 3 years
Quick Apply
Behavioral Health Leadership & Clinical Contract / Interim Engagements
SimiTree Talent Solutions —United States
- Full-time
- Psychiatry
- Addiction Medicine
- Senior level
- Travel reimbursement
Quick Apply

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RN REGISTERED NURSE ASSESSMENT COORDINATOR
Elan Skilled Nursing —Scranton, PA
Must posses a valid Pennsylvania nursing license. Ensures that all facility procedures related to the RAI process are followed to maintain all state and federal…
From $42 an hour
Quick Apply
3d
RN - Registered Nurse Coordinator - Neurology
Geisinger —Scranton, PA
Assists leadership in the design, implementation and evaluation of care coordination programs to support overall goals and strategic business strategies.
3d

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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
10d
Appeals Nurse Consultant (Remote)
CVS Health —Columbus, OH
Must have active and unrestricted RN licensure in state of residence. Qualified applicants with arrest or conviction records will be considered for employment…
$60,522 - $129,615 a year
4d

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Utilization Review Representative

Wyoming Valley Behavioral Health -
Kingston, PA

Quick Apply

Job Details

Full-time
$25 - $35 an hour

Benefits

Wellness program
Disability insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Opportunities for advancement

Qualifications

Collaborate with healthcare professionals
Electronic health records (EHR) management
Regulatory compliance
Patient management software
Analytics

Full Job Description

As Wyoming Valley Behavioral Health continues to expand, we’re excited to add an experienced full-time Utilization Review Representative to our growing Utilization Review department. The person will be responsible for reviewing and analyzing patient care to ensure the appropriate use of resources, adherence to clinical guidelines, and compliance with regulatory requirements.

Responsibilities:

Conduct thorough reviews of patient records and treatment plans to assess the necessity and appropriateness of medical services and interventions.
Evaluate clinical documentation to ensure it meets established standards and guidelines for care.
Collaborate with healthcare providers to discuss treatment plans and recommend modifications as needed to optimize patient outcomes and resource utilization.
Prepare and maintain detailed documentation of reviews, including rationale for decisions and recommendations for care adjustments.
Serve as a liaison between the facility and insurance companies or other third party payers to manage authorizations and claims.
Prepare and present reports on utilization metrics, including patterns, outcomes, and recommendations for process improvements.

Education:

Associate’s degree or higher in Nursing, Healthcare Administration or a related field

Qualifications:

Minimum of 1-2 years of experience in a healthcare setting, with a strong background in utilization review, case management, or clinical nursing.
Licensed RN/LPN preferred
Knowledge of clinical guidelines, regulatory requirements, and healthcare reimbursement processes.
Excellent analytical skills and attention to detail, with the ability to review and interpret complex clinical information.
Strong communication and interpersonal skills, with the ability to work collaboratively with healthcare professionals and external stakeholders.
Proficient in electronic health record (EHR) systems and utilization review software.
Certification in Utilization Review or related field (e.g., URAC, CCM) is a plus.

Exciting Benefits Await You:

Attractive Compensation: Enjoy competitive pay that truly values your contributions.
Generous Paid Time Off: Recharge and prioritize your well-being with ample PTO.
401(k) Plan: Secure your financial future with our strong retirement plan.
Flexible Daily Pay: Access your earnings whenever you need them.
Comprehensive Benefits Package: Benefit from a wide range of options, including dental, health, vision, and disability insurance.
Wellness Program Access: Prioritize your health with resources designed to support your well-being.
Inclusive Workplace Culture: Thrive in a supportive environment that champions diversity and collaboration.
Career and Educational Development: Unlock your potential with numerous opportunities for growth and advancement.
Comprehensive Onboarding and Professional Development Programs: Expertly crafted to cultivate growth and significantly enhance essential skills, paving the way for sustained success and excellence.

Salary/ Wage Range

Compensation for the role will depend on a number of factors, including a candidate’s qualifications, skills, competencies and experience and may fall outside of the range shown.

EEO Statement

We are committed to maintaining a diverse and inclusive workplace. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for our job opportunities.

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Refine Your Search

utilization review jobs in scranton, pa

Utilization Review Representative

RN REGISTERED NURSE ASSESSMENT COORDINATOR

Nurse Practitioner (PMHNP or FNP) - SUD & MH - Full-time

Physician Reviewer Multiple Specialties - TEXAS and NEW MEXICO

Nurse Reviewer RN

Medical Social Worker, Home Health (Part-time)

Clinical Liaison (Paramedic / Allied Health)

RN Clinical Liaision

Licensed Clinician (LPC, LCSW, LMFT)

Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)

Behavioral Health Leadership & Clinical Contract / Interim Engagements

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