- SR International, Inc. (Phoenix, AZ)
- …their own laptop SOAZ - Posting ID # 5297 - Medical Review Nurse (Local Only/Mostly Remote/ Onsite Trainings) Skills Required: *Medical nursing practice, medical ... NEED LOCAL ARIZONA RESIDENTS ONLY Candidate will go onsite for training 1-2 times for training once...case management protocols, quality management and … more
- UNC Health Care (Kinston, NC)
- …and well-being of the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care is provided ... the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of...Health Entity: UNC Lenoir Health Care Organization Unit: Care Management Work Type: Full Time Standard Hours Per Week:… more
- Actalent (Santa Barbara, CA)
- …efficiently to support member care plan goals. + Perform utilization management activities, which may include telephonic or onsite clinical review; case ... Remote Utilization Management RN Leading healthcare facility...Remote Utilization Management RN Leading healthcare facility that aims to...need is now looking for a REMOTE Health Plan Nurse Coordinator to join their team! Here you will… more
- Access Dubuque (Dubuque, IA)
- …1 Positions ID: 4823670008 Posted On 07/29/2025 Refreshed On 10/04/2025 **Job Overview** ** Utilization Management CNA** **Location** : Onsite in Dubuque, IA. ... Utilization Management CNA **Cottingham & Butler/...will also triage the call to determine if a Utilization Review Nurse is needed to complete… 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
- CVS Health (OH)
- …and every day. **Position Summary** This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a field-based/Remote position out ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... a full-time role and will be required to work onsite . *Purpose of this position: *Manages the design, development,...financial, and utilization goals through effective management , communication, and… more
- Texas Health Resources (Arlington, TX)
- Director Utilization Management -Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... leader for system services for wholly owned and Partner hospitals for utilization management . Job Duties OPERATIONS: Plans, organizes and delegates activities… more
- Elevance Health (Cerritos, CA)
- ** Utilization Management Representative II** **Location:** Virtual: This role enables associates to work virtually full-time in **CALIFORNIA** , with the ... shift between 8 am - 5 pm PST. The ** Utilization Management Representative II** is responsible for...providers. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Elevance Health (Miami, FL)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- CareFirst (Baltimore, MD)
- …of care. Utilizing experience and skills in both case management and utilization management , the Onsite Clinical Navigator will leverage proficiency in ... Based on hospital assignments and admission volumes on a week-to-week basis, management may occasionally approve the Onsite Clinical Navigator to perform… more
- HCA Healthcare (Asheville, NC)
- …Schedule: Monday-Friday 8am-430pm with a rotating weekend every 4 weeks. This position is onsite at Mission Hospital. The Registered Nurse (RN) CM is responsible ... a rotating weekend every 4 weeks. This position is onsite at Mission Hospital. Mission Hospital is committed to...patient-centered care?** Submit your application for Care Manager Registered Nurse position and spend more time at the bedside… more
- Elevance Health (Mason, OH)
- **Medical Management Nurse ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... will drive the future of health care. The **Medical Management Nurse ** is responsible for reviewing the...experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination… more
- ChenMed (Louisville, KY)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance,… more
- CenterWell (Anderson, SC)
- …proactive and sustained engagement in improving health outcomes, optimizing resource utilization , and ensuring effective panel management . + **Focus on ... part of our caring community and help us put health first** The Nurse Practitioner, Paneled applies advanced education and clinical competencies to achieve optimal… more
- State of Massachusetts (Boston, MA)
- …directing and supervising ALR Unit intake and reviewing such submissions. The Registered Nurse will evaluate ALR records during each onsite certification and ... Office of Aging and Independence (AGE) is seeking a highly motivated*Registered Nurse *to join our Assisted Living Residence (ALR) Certification Unit. This role… more
- ERP International (Yuma, AZ)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with ... databases for community resources, etc. + Integrate CM and utilization management (UM) and integrate nursing case...the certifications below **OR** Possess a Master's Degree in Nurse Case Management from a program accredited… more
- Veterans Affairs, Veterans Health Administration (New York, NY)
- …promotion, health education and coaching on wellness, disease prevention, and chronic care management . The nurse will assist in directing the provision of ... Summary The Manhattan VA is seeking one Registered Nurse for their Neurological Clinic. Responsible and accountable for all elements of the nursing process when… more
- Elevance Health (Houston, TX)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... ** Nurse Reviewer I** **Location:** This role enables associates...required. **Preferred Experience, Skills, and Capabilities:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- Elevance Health (Chicago, IL)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... **Appeals Nurse Reviewer I** **Location:** This role enables associates...required. **Preferred Experience, Skills, and Capabilities:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
