- Katmai (Fort Carson, CO)
- …Red Cross. + Three (3) years within the last four (4) years as a registered nurse in utilization management . + One (1) year of experience in UR/UM and ... Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE...full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- CVS Health (Austin, TX)
- …the department.** **Rotational late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical ... with diverse cultural dynamics of clinical staff and patients. Registered Nurse ( RN ) required. Licensed...(LCSW) preferred. + Requisition Job Description **Position Summary** This Utilization Management (UM) Nurse Consultant… more
- Centene Corporation (Sacramento, CA)
- …degree and 4+ years of related experience. Knowledge of utilization management principles preferred. Must have a CA RN License **License/Certification:** + ... ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks... RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Commonwealth Care Alliance (Boston, MA)
- … Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management … more
- UNC Health Care (Morrisville, NC)
- …the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible ... for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a complex academic health system and… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- Summary The Patient Flow - Utilization Management Coordinator Registered Nurse ( RN ) considers all characteristics of the individual, in order to ... to: The primary purpose of the Patient Flow - Utilization Management Coordinator RN position...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …process and initiatives as well as customer service programs. The Utilization Management /Float Registered Nurse ( RN ) is responsible for providing ... Center is looking for recruit for Registered Nurse - Utilization Management /...the Associate Director of Patient Care Services (ADPCS). The Utilization Management /Float ( RN ) follows procedures… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Nov 30, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career ... care and their communities. Role Overview: The role of Utilization Management Manager oversees the integration of...and clinical criteria evaluations.They will possess a current unrestricted RN license from the State of Indiana; a minimum… more
- McLaren Health Care (Bay City, MI)
- …duties as required and directed. #LI-LM1 **Qualifications:** _Required_ + State licensure as a registered nurse ( RN ) + Bachelor's degree in nursing from ... **Department:** Utilization Management **Shift:** Days **Daily Work Times:** 8am - 4:30pm **Scheduled Hours per Pay:** 40 Position Summary: Responsible for… more
- McLaren Health Care (Port Huron, MI)
- …related duties as required and directed. **Qualifications:** Required ⦁ State licensure as a registered nurse ( RN ) ⦁ Bachelor's degree in nursing from ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- CVS Health (Harrisburg, PA)
- …And we do it all with heart, each and every day. **Position Summary** This Registered Nurse Utilization Management position is an exciting opportunity ... management inquiries, and ensure optimal patient outcomes. **Required Qualifications** Registered Nurse ( RN ), preferably in a compact state 3-5… 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
- 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
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer Success Organization who will provide clinical ... best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as...acute care setting + 2+ years of experience in utilization management + Knowledge and understanding of… more
- CVS Health (Salem, OR)
- …we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical skills to ... hospital clinical practice. + Must have active and unrestricted RN ( _Registered Nurse_ ) Licensure in the state...Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in… more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- …coordination. Responsibilities The Utilization Management (UM) Consultant Registered Nurse ( RN ) demonstrates leadership, experience, and creative ... Summary The Hines VA Utilization Management (UM) RN ...Summary The Hines VA Utilization Management (UM) RN reports to the...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Intermountain Health (Las Vegas, NV)
- …+ Continuous Improvement + Scheduling **Physical Requirements:** **Minimum Qualifications** + Current Registered Nurse ( RN ) license in state of practice ... including social work and complex care planning, transitions of care, and utilization management . The position ensures compliance with state, national, and… 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...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more