- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical ... to establish the most appropriate course of action + Provides education to nurse and therapist reviewers regarding appeal updates and process changes + Maintains… more
- Commonwealth Care Alliance (Boston, MA)
- …Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- ERP International (Tinker AFB, OK)
- **Overview** ERP International, LLC is seeking a ** Registered Nurse - Case Manager** for a full-time position supporting **SHG Clinic** in support of **Tinker ... for community resources. - Integrate CM and utilization management ( UM ) and integrating nursing case management with social work...or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction. Security**… more
- HealthCare Support (Houston, TX)
- Utilization Review RN HealthCare Support is actively seeking a Utilization Review RN to fill an opening with a Prestigious HealthCare Company in Remote Houston ... TX . Daily Responsibilities for Utilization Review RN : WIll need to use their OWN EQUIPMENT: 2...required information into the managed care platform, adhering to UM policies and procedures. 5. Assists in the coordination… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …or four (4) years' work experience **(Required)** + Current State Licensure as a registered nurse where licensing is required by State law **(Required)** + Three ... our Healthsource blog: https://healthsource.premera.com/ . The **Care Coordinator - Inpatient RN ** performs reviews of admissions and concurrent stay requests for… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …or four (4) years' work experience (REQUIRED) + Current State Licensure as a registered nurse (REQUIRED) + Three (3) years of clinical experience (REQUIRED) + ... and ensures these requirements are accurately followed and Utilization Management ( UM ) decision determinations and timeliness standards are within compliance. +… more
- Stony Brook University (Stony Brook, NY)
- …and other duties as required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN license and working history ... RN Case Manager **Position Summary** At Stony Brook...their work and follow up with cases. **Preferred:** CM, UM , Quality, Coding, Risk or MCG Certification Working knowledge… more
- Commonwealth Care Alliance (Boston, MA)
- …dental and other vendors to assure integration, oversight, and efficiency of UM processes and functions. - Ensures compliance with all contract requirements, state ... the CMO and VPMA to develop and advance the UM program and leads and organizes the ongoing evaluation...or Health related field preferred Required Licensing: - active RN license required Required Experience: - 7-10 years -… more
- Commonwealth Care Alliance (Boston, MA)
- …external audits (eg CMS Program Audits, or EQRO reviews). - Hire, train and mentor UM staff, including nurse reviewers and support personnel. - Act as liaison ... and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized clinical review and… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. This ... clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a ... you'll bring:** + Current and unrestricted NY & VT RN licensure + Associate or bachelor's degree in nursing...+ Experience with electronic medical record (EMR) systems and UM platforms. + Familiarity with CMS regulations and appeals… more
- UPMC (Pittsburgh, PA)
- UPMC Home Health is Hiring a Full-Time Registered Nurse ( RN ) for the Uniontown and Surrounding Areas Are you a nurse looking for a rewarding career where ... care in the comfort of their homes. As an RN with UPMC Home Health, you'll collaborate with our...Licensure, Certifications, and Clearances: + Current licensure as a Registered Professional Nurse either in the state… more
- United Methodist Communities (Wall Township, NJ)
- Wall Township, NJ, USA | Other | 75 per visit | Per Diem RN : Registered Nurse Payrates up to $75/visit! United Methodist Communities, HomeWorks, is a rapidly ... and encouraging team! Requirements: + Current and valid NJ RN License + Current and valid Driver's License Abou t UM C: + Our Mission is to serve our community… more
- AdventHealth (Orlando, FL)
- …creating a holistic environment. **The role you'll contribute:** The role of the Utilization Management ( UM ) Registered Nurse ( RN ) is to use clinical ... hospital admission, treatment, and appropriate level of care. The UM RN leverages the algorithmic logic of...and valid license to practice in Florida as a Registered Nurse (ADN or BSN) required. +… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : University Hospital (Adult Emergency Services Graduate Nurse Internship) Apply Now **How to Apply** This is a "multiple-fill" job opening: ... Services Internship program, **starting January 8, 2026** . The UM Adult ED is a Level 1 Trauma Center...month internship program which prepares Graduate Nurses for a Registered Nurse position in the Emergency Department.… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : University Hospital (Adult Emergency Services) Apply Now **Mission Statement** Michigan Medicine improves the health of patients, populations ... no-cost CEs and professional development for advancement **Responsibilities The UM Adult ED is a Level 1 Trauma Center...Nurse Recruitment at ###. **Required Qualifications Current Michigan Registered Nurse License. One (1) year of… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : University Hospital (Central Staffing Resources, Adult Critical Care Cluster) Apply Now **Job Summary** This RN would be part of our ... a competitive salary with excellent benefits!** Hourly range for Registered Nurses **$41.78-$64.81/ hour** CSR RN 's will...20 hours/week may be combined. **Required Qualifications Current Michigan Registered Nurse License. Two (2) or more… more
- Magellan Health Services (Boise, ID)
- …Professional Counselor - Care MgmtCare Mgmt, PC - Professional Counselor - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - ... required: BCBA, LCSW, LMFT, LMSW, LPCC, LPC, PC or RN . If RN , BSN preferred but ASN...provider. General Job Information Title Clinical Manager, Behavioral Health ( UM ) -Licensed, Remote in Idaho Grade 27 Work Experience… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : Central Staffing Resources (Pediatric Critical Care Cluster) Apply Now **Job Summary** This is a Central Staffing Resource RN position ... hour Night Shift Weekend Differential- $6.90 / hour Charge Nurse Differential- $1.00 / hour CSR RN 's...Recruitment at ###. **Required Qualifications Current licensure as a Registered Nurse in the State of Michigan.… more
- University of Michigan (Ann Arbor, MI)
- …Qualifications + BSN preferred + One (1) year experience as a Registered Nurse + Previous Medical Surgical RN exp **Work Schedule** Hours: 24 hrs/wk Shift: ... REGISTERED NURSE : University Hospital 4A-1 Adult...Nurse Recruitment at ###. **Required Qualifications Current Michigan RN license **GN applicants will be considered for this… more
