- Ventura County (Ventura, CA)
- Per Diem Registered Nurse II/III - Utilization Management ... II + Six (6) months of experience in Utilization Management Per Diem RN III ... VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply Per Diem Registered Nurse II/III - Utilization Management VCMC… more
- UNC Health Care (Morrisville, NC)
- …the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible ... for designing, implementing, and standardizing utilization management functions across a large healthcare...Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate… more
- Adecco US, Inc. (Minneapolis, MN)
- …**Pay** : $40.00 - $43.25 per hour based on experience **Responsibilities of the Utilization Management Nurse ** : . Responsible for reviewing proposed ... Generally work is self-directed and not prescribed. . The Utilization Management Nurse works under...of an RN or MD. . Performs utilization review activities, including pre-certification, concurrent, and… more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse ! Job...+ Clinical review + Utilization review + Utilization management + ... Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary team to...+ Valid Florida Driver's License. + Knowledge of case management and utilization review concepts,… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse ( RN )** for a full-time position supporting the 2d Medical ... in Utilization Management is required. Full time employment as a registered nurse within the last 36 months is mandatory. Six years of clinical… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - ... The System Utilization Management [SUM] Utilization Review RN is responsible...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
- 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 ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …groups and clinical committees. Essential Qualifications + Active and unrestricted license as a Registered Nurse ( RN ). + Bachelor's degree in nursing, (or ... About The Role The Director, Utilization Management (UM) will manage the...results and ensure existing and new regulatory initiatives. + Review multiple reports for statistical and financial tracking purposes… more
- McLaren Health Care (Indianapolis, IN)
- We are looking for a Utilization Management RN , to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- Veterans Affairs, Veterans Health Administration (Houston, TX)
- Summary The Registered Nurse Utilization Management Registered Nurse delivers fundamental knowledge-based care to assigned clients while ... Major Duties (To include but not limited to): The Registered Nurse Utilization Management...with increased levels of self-direction. Uses Utilization Management criteria to perform basis review while… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role in ensuring CCA ... Reviewer reports to the Utilization Management Manager. * Conducts timely clinical decision review...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Alameda Health System (Oakland, CA)
- …+ FTE:1 + Posted:July 18, 2025 **Summary** **SUMMARY:** The System Utilization Management (SUM) Care Without Delay RN is a pivotal role responsible for ... System Utilization Management SUM Specialist + Oakland,...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- CVS Health (Baton Rouge, LA)
- …work._ **Required Qualifications** + 1 year of varied UM ( utilization management ) experience within an **outpatient** setting, concurrent review or prior ... make thorough, independent decisions using clinical judgement. + A Registered Nurse that must hold an unrestricted...+ 1 year of varied UM ( utilization management ) experience within an inpatient, concurrent review … more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Corewell Health (Southfield, MI)
- …degree. + Preferred Bachelor's Degree in nursing or related field. + Hospital utilization review / utilization management experience. Preferred + Clinical ... Scope of Work This role includes accountability for utilization review (UR) and may include...2 years of experience in clinical/hospital setting. Required + Registered Nurse ( RN ) - State… more
- CareFirst (Baltimore, MD)
- …+ Proficient in Microsoft Office programs. **Licenses/Certifications Required Upon Hire** : Health Services\ RN - Registered Nurse - State Licensure and/or ... week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages… more