- CVS Health (Austin, TX)
- …role is 100% remote and the candidate can live in any state. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, ... with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant...document and communicate all aspects of the utilization /benefit management program. You would be responsible… 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 ... 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
- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests ... working remotely. Primary Responsibilities * Performs behavioral health clinical utilization reviews using evidenced based guidelines, policies and nationally… more
- CVS Health (Raleigh, NC)
- …all with heart, each and every day. **Position Summary** Medicare Precertification Utilization Management Nurse Consultant position: _Utilization ... with occasional holiday rotation.** **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience +… more
- Brighton Health Plan Solutions, LLC (NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests ... coverage while working remotely. Primary Responsibilities * Performs clinical utilization reviews using evidenced based guidelines, policies and nationally… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team ... internal partners (eg, Provider Relations, Quality) to resolve escalations and address utilization management issues. + Represent UM nursing team in internal… 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
- CVS Health (Harrisburg, PA)
- …we do it all with heart, each and every day. **Position Summary** This Registered Nurse Utilization Management position is an exciting opportunity to join a ... current review stays. **Primary Job Duties & Responsibilities** Drives effective utilization management practices by ensuring appropriate and cost-effective… more
- CVS Health (Lansing, MI)
- … solutions that promote high-quality healthcare for members. **Position Summary** Join our Utilization Management team as a Nurse Consultant, where you'll ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- Summary The Utilization Management (UM) Registered Nurse (RN) executes position responsibilities that demonstrate leadership, experience, and creative ... standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Preferred Experience: Master's prepared Registered Nurse . 5 years Utilization Management … 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
- AdventHealth (Tampa, FL)
- …such as heart failure, cancer and other diseases. **The role you'll contribute:** The Utilization Management nurse uses clinical expertise to review patient ... + 5 years Clinical nursing in an acute care setting - preferred + Utilization Management or Care Management - preferred This facility is an equal opportunity… more
- ERP International (Vandenberg AFB, CA)
- **Overview** ERP International is seeking a full-time **Registered Nurse (RN) Utilization Management ** for a temporary contract position in support of ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- CVS Health (Harrisburg, PA)
- …and more compassionate. And we do it all with heart, each and every day. Utilization Management is a 24/7 operation and work schedule may include weekends, ... + 3+ years clinical practice experience as a Registered Nurse preferably in an acute setting (ex: OR, ER,...and unrestricted RN licensure in state of residence + Utilization Management is a 24/7 operation and… more
- CVS Health (Trenton, NJ)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in ET and CT zones… more