• Appcast (Randallstown, MD)
    Utilization Review Nurse RN Randallstown, MD NORTHWEST HOSPITAL NW CARE MANAGEMENT Full-time - Day shift - 8:00am-4:30pm RN Other 92327 $38.20-$59.21 ... system that values bold ideas and community-centered care. The Utilization Review Nurse RN... review cases not met with criteria REQUIREMENTS: Registered Nurse License - Current Maryland license… more
    Talent (10/03/25)
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  • Utilization Review Manager

    Minnesota Visiting Nurse Agency (Minneapolis, MN)
    *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to work ... ) required or completed within three years of hire **Title:** * Utilization Review Manager * **Location:** *MN-Minneapolis-Downtown Campus* **Requisition… more
    Minnesota Visiting Nurse Agency (09/30/25)
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  • Utilization Management Manager

    State of Indiana (Indianapolis, IN)
    …role of Utilization Management Manager oversees the integration of utilization review , clinically appropriate care and risk management for the purpose of ... Utilization Management Manager Date Posted: Sep...and clinical criteria evaluations.They will possess a current unrestricted RN license from the State of Indiana; a minimum… more
    State of Indiana (09/26/25)
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  • Utilization Manager

    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 ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
    Commonwealth Care Alliance (10/02/25)
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  • Manager , Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... Knowledge, Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization, concurrent and retrospective… more
    Commonwealth Care Alliance (10/02/25)
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  • RN , Manager , Utilization

    Humana (Augusta, ME)
    …areas. **Use your skills to make an impact** **Required Qualifications** + An active, unrestricted Registered Nurse ( RN ) license in the state of Michigan. + ... caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization...Previous experience in utilization management and/or utilization review .… more
    Humana (09/28/25)
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  • Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of...care to MCC in response to physician order, or review of updated clinical information + Acts as a… more
    Catholic Health Services (07/24/25)
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  • Manager - Utilization Review

    Beth Israel Lahey Health (Plymouth, MA)
    …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... **Join Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff… more
    Beth Israel Lahey Health (07/29/25)
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  • Utilization Manager Reviewer

    Excellus BlueCross BlueShield (Rochester, NY)
    …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
    Excellus BlueCross BlueShield (08/23/25)
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  • RN or LPN - Utilization

    Northeast Alabama Regional Medical Center (Anniston, AL)
    …years of clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred. Extensive knowledge and understanding of ... stay reviews to assure hospitalizations meet payor requirements. Maintains records of review information and outcomes for billing purposes and for compliance with… more
    Northeast Alabama Regional Medical Center (09/27/25)
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  • Utilization Management Manager

    CareFirst (Baltimore, MD)
    …+ Proficient in Microsoft Office programs. **Licenses/Certifications Required Upon Hire** : Health Services\ RN - Registered Nurse - State Licensure and/or ... required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership experience.… more
    CareFirst (07/12/25)
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  • Manager , Utilization Review

    Children's Mercy Kansas City (Kansas City, MO)
    …+ Experience in Utilization Review + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + ... training oversight of programs and services. Responsible for effective utilization review and proper resource management of...One of the following: Licensed RN - Kansas, Registered Nurse more
    Children's Mercy Kansas City (09/16/25)
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  • Outcomes Manager , Utilization

    Virtua Health (Pennsauken, NJ)
    …Nursing.Training/Certifications/Licensure:Licensure from the State of New Jersey as a Registered Nurse .Case Management Certification (requirement within one year ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
    Virtua Health (08/26/25)
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  • Case Manager ( RN )…

    Prime Healthcare (Chino, CA)
    …experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 ... an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing experience… more
    Prime Healthcare (09/30/25)
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  • Care Manager , Registered

    Sutter Health (Roseville, CA)
    …patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely ... + Bachelor's in Nursing preferred. **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
    Sutter Health (09/26/25)
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  • Case Manager II, Registered

    Sutter Health (Burlingame, CA)
    …patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely ... of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon...management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation… more
    Sutter Health (09/19/25)
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  • Utilization Management Rn

    Actalent (Santa Barbara, CA)
    …+ Very collaborative, supportive and helpful team + Fully remote!! REQUIREMENTS: + California Registered Nurse ( RN ) and/or Nurse Practitioner (NP) ... Remote Utilization Management RN Leading healthcare facility...such as Mental/Behavioral Health services. Skills: Care plans, Case Manager , Pediatrics, Utilization Management, Clinical Reviews Experience… more
    Actalent (10/01/25)
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  • Utilization Review Nurse

    Dayton Children's Hospital (Dayton, OH)
    …Details:Under the supervision of the Manager of Utilization Management, the Utilization Review RN conducts medical record review for medical ... medical guidelines and communicates information to payers in accordance with contractual obligations. The Utilization Review RN serves as a resource to the… more
    Dayton Children's Hospital (10/04/25)
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  • RN Care Manager - Rex Case…

    UNC Health Care (Raleigh, NC)
    …effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly organized ... from CAPP as appropriate. As necessary meet with the Utilization Manager (UM) and SW after the...date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North… more
    UNC Health Care (09/28/25)
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  • RN Care Manager - (Per Diem) Care…

    UNC Health Care (Smithfield, NC)
    …effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly organized ... from CAPP as appropriate. As necessary meet with the Utilization Manager (UM) and SW after the...date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North… more
    UNC Health Care (08/25/25)
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