- Appcast (Baltimore, MD)
- Registered Nurse - Sinai Hospital - OROC Sign On... Designated provider team (MDs/ APPs) available with Care Management support JOB SUMMARY: As a member of the ... OUTPATIENT RAPID OBS Full-time w/Weekend Commitment - Day shift - 7:00am-7:30pm Staff Nurse 90568 $35.00-$54.82 Experience based Posted: July 3, 2025 Apply Now Save… more
- Humana (Little Rock, AR)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and ... most appropriate treatment, care, or services for Enrollees. The Utilization Management Nurse Lead coordinates...Up to 5 associates. **WAH Internet Statement** To ensure Home or Hybrid Home /Office employees' ability to… more
- Humana (Frankfort, KY)
- **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...This hybrid position will have limited hours working at home at the leader's discretion. This is an Onsite… more
- UCLA Health (Los Angeles, CA)
- …for Medicare Advantage population enrolled under UCLA Medical Group. The ICM Medicare Advantage Utilization Review Nurse ensures that home health and durable ... direction of the Assistant Director, the ICM Medicare Advantage Utilization Review Nurse performs utilization ...resource utilization under the UCLA Medical Group Utilization Management guidelines. In this role, you… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in… more
- Wellpath (Fort Lauderdale, FL)
- …for training, education, and point of care support. **How you make a difference** The Utilization Management Registered Nurse works under the guidance of the ... accordance with applicable state and local laws. Quick Apply (https://careers-wellpath.icims.com/jobs/181904/ utilization - management -registered- nurse -%28rn%29/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336175207) **Need help finding the… more
- CVS Health (OH)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + UMNC meets set productivity and ... every day. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr days...telephone and typing on the computer. + Work from home position: During work hours, Colleagues who are working… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- Utilization Review Nurse (40 Hour) Office/On-site...Valley Hospital (CVH), Blue Hills Campus + UNIT : Utilization Management Unit + ADDRESS : 500 ... Services (DMHAS (https://portal.ct.gov/dmhas) ), is seeking to hire a Utilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&LinkSpec=RecruitNum2&R1=&R3=) at the Blue… more
- Signature Healthcare (Louisville, KY)
- …communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses. + Coordinate internal and external health ... RUG system. Previous experience with MDS and assessment preferred Hospital Case Management /Hospital Utilization Management . Obtaining authorizations from… more
- Truman Medical Centers (Kansas City, MO)
- …time **Work Schedule** 7:00AM - 3:30PM **Hours Per Week** 4 **Job Description** ** Utilization Management Nurse (UM RN)** _Optimize Care. Improve Outcomes. ... into myWORKDAY (http://www.myworkday.com/trumed/d/ home .htmld) to search for positions and apply.** Utilization Management RN Hourly (PRN) - Care Continuity -… more
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
- Humana (Augusta, ME)
- …a part of our caring community and help us put health first** The Manager, Utilization Management Nursing (LTSS Utilization Management Leader) utilizes ... communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and… more
- Humana (Lincoln, NE)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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 Position ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II...but not limited to: Skilled nursing facility, outpatient needs ( home health, physical therapy, infusion), and case management… more
- Access Dubuque (Dubuque, IA)
- Utilization Management CNA **Cottingham & Butler/...will also triage the call to determine if a Utilization Review Nurse is needed to complete ... SISCO** 1 Positions ID: 4823670008 Posted On 07/29/2025 **Job Overview** ** Utilization Management CNA** **Location** : Onsite in Dubuque, IA. Also accepting… more
- Humana (Frankfort, KY)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... expected to work a portion of their week from home and a portion of their week at a...medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care.… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Sanford Health (Fargo, ND)
- …** **Job Summary** Provides expertise and leadership to ensure effective resource management for patient care delivery across the care continuum for assigned patient ... patient wellness through evidenced based practice, improved care outcomes, efficient utilization of health services, and appropriate level of care for patients… more