- Alameda Health System (Oakland, CA)
- …plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic ... hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care....Required Licenses/Certifications : Valid license to practice as a Registered Nurse in the State of California.… more
- University Health (San Antonio, TX)
- …of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager ... Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred....full time hospital experience preferred. Work experience in case management , utilization review, or hospital quality assurance… more
- University Health (San Antonio, TX)
- …of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is preferred. Case Manager ... Three years recent, full-time hospital experience preferred. Work experience in case management , utilization review or hospital quality assurance experience is… more
- Humana (Denver, CO)
- …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
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Cottingham &... Practitioner - Dubuque, IA - Compet MercyOne OR RN - Operating Room Registered Nurse ... 4627707008 Posted On 07/01/2025 Refreshed On 11/23/2025 **Job Overview** ** Utilization Management Nurse ** **Location** :...Nurse - 4 day work wee Medical Associates RN - Float Pool Registered Nurse… more
- Actalent (Minnetonka, MN)
- Utilization Management Nurse Job...+ Proficiency in prior authorization processes. + Active, unrestricted RN license in the state of MN or WI. ... Description As a Utilization Management Nurse for Post Acute care, you will be responsible...necessity of post-acute stays. Essential Skills + Expertise in utilization management and utilization review.… more
- CVS Health (Baton Rouge, LA)
- …we do it all with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for Prior Authorization conducts ... in quality improvement, policy review, and education related to utilization management . * Serve as a clinical...and data integrity **Required Qualifications** * Active, unrestricted Louisiana RN license or compact license * Minimum 3 years… more
- CVS Health (Baton Rouge, LA)
- …And we do it all with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for NICU Concurrent Review conducts ... review, and education related to NICU and special populations utilization management . * Serve as a clinical...detail and data integrity **Required Qualifications** * Active, unrestricted RN license in Louisiana or a compact license. *… more
- CVS Health (Phoenix, AZ)
- …that promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- CVS Health (Columbus, OH)
- …a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, ... initiate a Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners...etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management… more
- Saint Francis Health System (OK)
- …in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the details ... Nursing. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 2 years of… more
- 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
- 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
- CVS Health (Columbus, OH)
- …and type on the computer. **Preferred Qualifications** Utilization Management experience preferred **Education** Diploma RN acceptable; Associate degree/BSN ... quality expectations as established by UMNC. **Required Qualifications** + Registered Nurse + 3+ years of experience...in acute or post-acute setting, and 1+ years of Utilization Management / Care Management … more
- CVS Health (Hartford, CT)
- …members. This position does require a weekend schedule. **Required Qualifications** + Registered Nurse + Education: Diploma RN acceptable;Associate ... Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma RN acceptable;… more
- CVS Health (Harrisburg, PA)
- …training sessions, or other events as directed. **`** **Required Qualifications** + Registered Nurse + Education: Diploma RN acceptable;Associate degree/BSN ... preferred, 3+ years of experience as a Registered Nurse , 1+ years of clinical experience...in acute or post-acute setting, and 1+ years of Utilization Management / Care Management … more
- CVS Health (Harrisburg, PA)
- …active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, ... all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and...**Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care… more
- CVS Health (Austin, TX)
- …sessions, or other events as directed. **`** **Required Qualifications** + Registered Nurse + Education:Diploma RNacceptable;Associate degree/BSN preferred, 3+ ... years of experience as a Registered Nurse , 1+ years of clinical experience...experience in acute or post-acute setting,and 1+ years of Utilization Management / CareManagementExperience + Must have… more
- Sanford Health (Rapid City, SD)
- …experience preferred. Experience in medical necessity review preferred. Currently holds an unencumbered registered nurse ( RN ) license with the State Board of ... providing direct supervision of all departmental staff. Maintains a standardization of utilization management process to ensure all policies and procedures are… more
- CVS Health (Austin, TX)
- …/benefit management function. **Required Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN ... of experience with Microsoft Office applications (Outlook, Teams, Excel) + Utilization Management is a 24/7 operation and work schedules will include holidays… more
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