- 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 ... adapting to ad hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care. DUTIES & ESSENTIAL JOB… more
- University Health (San Antonio, TX)
- …years recent, full time hospital experience preferred. Work experience in case management , utilization review, or hospital quality assurance experience is ... and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to… more
- University Health (San Antonio, TX)
- …Three years recent, full-time hospital experience preferred. Work experience in case management , utilization review or hospital quality assurance experience is ... hire date. LICENSURE/CERTIFICATION Current license from the Board of Nurse Examiners of the State of Texas to practice...the State of Texas to practice as a registered nurse is required. National certification in related field 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Cottingham & Butler/ SISCO** 1 Positions ID: 4627707008 Posted On 07/01/2025 Refreshed On 11/23/2025 **Job Overview** ** ... Utilization Management Nurse ** **Location** : Onsite in Dubuque, IA. Also accepting remote applicants. We are looking for a nurse just like you - a … more
- Actalent (Minnetonka, MN)
- Utilization Management Nurse Job Description As a Utilization Management Nurse for Post Acute care, you will be responsible for reviewing and ... the medical necessity of post-acute stays. Essential Skills + Expertise in utilization management and utilization review. + Experience in acute care and… 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 ... * Participate in quality improvement, policy review, and education related to utilization management . * Serve as a clinical resource for internal and external… 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 ... improvement, policy review, and education related to NICU and special populations utilization management . * Serve as a clinical resource on NICU care for… 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. ... use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed, ensuring… 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)
- …their placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers ... not all inclusive nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location: Virtual Office, Oklahoma 73105… more
- Katmai (Fort Carson, CO)
- …American 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 ... Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE...active, and unrestricted license to practice as a registered nurse . + Must be a graduate from a college… 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 ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA… more
- CVS Health (Columbus, OH)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... on the telephone, and type on the computer. **Preferred Qualifications** Utilization Management experience preferred **Education** Diploma RN acceptable;… more
- CVS Health (Harrisburg, PA)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... Nursing Licenses as business needs require. * **Preferred Qualifications** - Utilization Management experience preferred **Education** Associates Degree BSN… more
- CVS Health (Harrisburg, PA)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CVS Health (Hartford, CT)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma… more
- Sanford Health (Rapid City, SD)
- …providing direct supervision of all departmental staff. Maintains a standardization of utilization management process to ensure all policies and procedures are ... Hours:** 40.00 **Department Details** Join our team as a Utilization Review and Case Management Manager and...medical necessity review preferred. Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing… more
- CVS Health (Austin, TX)
- …years of clinical experience in acute or post-acute setting,and 1+ years of Utilization Management / CareManagementExperience + Must have active current and ... obtainadditionalNursing Licenses as business needsrequire. * **Preferred Qualifications** - Utilization Management experience preferred - **Anticipated Weekly… more
- CVS Health (Austin, TX)
- …+ 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel) + Utilization Management is a 24/7 operation and work schedules will include ... holidays and evening hours **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience + Experience using… more
Related Job Searches:
Management,
Nurse,
Nurse Utilization Management Reviewer,
RN Utilization Management Nurse,
Registered Nurse Utilization Management,
Telephonic Utilization Management Nurse,
Utilization,
Utilization Management Nurse Consultant,
Utilization Management Nurse Home,
Utilization Management Nurse Specialist