- Houston Methodist (The Woodlands, TX)
- …two years in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure - ... Nurse (URN) PRN position is a licensed registered nurse ( RN ) who comprehensively...state, local, and federal programs + Progressive knowledge of utilization management , case management… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time ... **Location** : Holy Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management ,...resource for navigating post-acute care services. **Minimum Qualifications:** + RN licensed by the State of Maryland or Compact… more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management /ReviewDepartment:Patient Services-Patient Care ... a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current...license as a Registered Nurse ( RN ) + A certification as a Certified Case… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - ... 14, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN ...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
- Beth Israel Lahey Health (Burlington, MA)
- … Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse ( RN ) Case Manager for Hospital at Home Care ... a timely process. Registered Nurses (RNs) with utilization review experience, case management ...the needs of the department. **Minimum Qualifications:** Education: * Registered Nurse , Bachelors Degree or commensurate experience… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Adecco US, Inc. (Minneapolis, MN)
- …**Pay** : $40.00 - $43.25 per hour based on experience **Responsibilities of the Utilization Management Nurse ** : . Responsible for reviewing proposed ... Generally work is self-directed and not prescribed. . The Utilization Management Nurse works under...states . 2+ years of experience in managed care, Utilization Review, Case Management or… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN ...an acute hospital setting. At least 2 years of Utilization Management / Case Management ... achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Houston Methodist (Sugar Land, TX)
- …three years in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure - ... Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) who comprehensively...state, local, and federal programs + Comprehensive knowledge of utilization management , case management… more
- Brockton Hospital (Brockton, MA)
- …while optimizing resource utilization . Provides training to staff on case management methods and techniques. Establishes monitoring mechanisms to identify ... and develops reports that clearly monitor all areas of utilization / case management . Provides data, guidance...RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts… more
- Alameda Health System (Oakland, CA)
- …+ FTE:1 + Posted:July 18, 2025 **Summary** **SUMMARY:** The System Utilization Management (SUM) Care Without Delay RN is a pivotal role responsible for ... Required Experience: Minimum three (3) years of experience in Utilization Management or Case ...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
- Holzer Health System (Gallipolis, OH)
- …organizational and financial outcomes. Serves as a clinical expert and resource in Utilization Review and Case Management . Partners with Social Workers ... . A minimum of three years experience as a registered nurse in acute care for adult...will be taken into consideration. . Professional experience with case management , utilization review, or… more
- US Tech Solutions (Hopewell, NJ)
- …/care/disease management principles. + Requires working knowledge of operations of utilization , case and/or disease management processes. - Requires ... eligibility requirements. + Requires mentoring knowledge on the operations of utilization / case /disease management . **Education:** + Requires an associate… more
- Humana (Charleston, WV)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...in nursing (BSN) + Previous experience in discharge planning, utilization management or case … more
- WellSpan Health (Lebanon, PA)
- …to 4pm Weekend rotation **General Summary** Performs a variety of duties and applies utilization and case management techniques to determine the most ... patient discharge needs. Provides leadership in the integration of utilization and case management principles...., or Clinical Nursing Specialty. Preferred **Licenses:** + Licensed Registered Nurse Upon Hire Required or +… more
- Henry Ford Health System (Detroit, MI)
- $15,000 sign on bonus available for qualified experienced candidates with current 2 years RN Case Management in a large acute care hospital setting. GENERAL ... with computers, electronic health records (EHR), database systems, and utilization review/ case management documentation systems....work in a fast-paced environment. Licenses and Certifications: + Registered Nurse ( RN ) with a… more
- BriteLife Recovery (Englewood, NJ)
- …assigned What we need from you? + Minimum of 2-3 years of experience in utilization review, case management , or insurance coordination in a behavioral health ... compliance. + Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials, approvals,… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/ case management /clinical/or combination; 2 of ... hire) **Job Description:** + NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience...the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- UPMC (Washington, PA)
- …care/treatment, The Joint Commission Standards, Federal/State regulations relative to utilization / case management , discharge planning, Medicare, Medicaid, ... The Manager oversees the day-to-day operations of the Case management department under the direction...team performance and desired patient outcomes is needed. + Registered Nurse ( RN ) *Current licensure… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is...player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more