- Martin's Point Health Care (Portland, ME)
- …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of the Utilization ... requests for services requiring clinical review prior to payment. The Utilization Review Nurse will use appropriate governmental policies as well as… more
- UPMC (Pittsburgh, PA)
- …prepayment , and post payment review of high dollar claims, and prepayment review of diagnosis and procedural codes. Responsibilities will involve working ... related to clinical guidelines, coding requirements, regulatory requirements, and resource utilization . This includes using vast clinical knowledge to ensure correct… more