- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Conifer Revenue Cycle Solutions (Frisco, TX)
- …with Medicare Part B Knowledge of disease pathophysiology and drug utilization Knowledge of MS-DRG classification and reimbursement structures PC/Systems literate ... as a means to measure query process Report writing with management review Skilled in performing quality assessment/analysis Overall knowledge and ability to drive… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… more
- AdventHealth (Orlando, FL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... that **together** we are even better. **Schedule:** Full Time Remote , Applicant must live within a 50-mile radius or...environment. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is… more
- CVS Health (Phoenix, AZ)
- …for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role, you'll be at the ... times may vary based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc....intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or… more
- CVS Health (Phoenix, AZ)
- …difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and Transplant, ... in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position… more
- CVS Health (Richmond, VA)
- …Summary** This Utilization Management Nurse Consultant (UMNC) position is 100% remote . As a Utilization Nurse Consultant, you will utilize clinical ... environment. Through the use of clinical tools and information/data review , the UM Nurse Consultant reviews services...and Word -Strong telephonic communication skills -1+ years of Utilization Review experience -1+ years of Managed… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Cottingham & Butler/ SISCO** 1 Positions ID: 4627707008 Posted On 07/01/2025 Refreshed On 10/23/2025 **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
- Henry Ford Health System (Warren, MI)
- …Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical experience required. +… more
- CVS Health (Des Moines, IA)
- …healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key Responsibilities** + Apply ... some weekends and holidays, per URAC and client requirements. ** Remote Work Expectations** + This is a 100% ...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
- CVS Health (Albany, NY)
- …all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state ... 8:30am - 5pm EST. This role is a registered nurse that utilizes MCG rules and applies medical necessity...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of… more
- Molina Healthcare (GA)
- …performance of one or more of the following activities: care review , care management, utilization management (prior authorizations, inpatient/outpatient medical ... This position will offer remote work flexibility, however, the selected candidate must...some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and… more
- Molina Healthcare (GA)
- This position will offer remote work flexibility, however, the selected candidate must reside in the state of Georgia. This position will require RN Licensure. JOB ... services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- Centene Corporation (Honolulu, HI)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... organization offering competitive benefits including a fresh perspective on workplace flexibility. Remote Position. Must Reside in Hawaii Registered Nurse (RN)… more
- CVS Health (Little Rock, AR)
- …on business needs) Travel Required up to 5% for meetings/audits. Location: 100% Remote (US only) **About Us** American Health Holding, Inc. (AHH), a division of ... **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development and… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Full- time and will work 8-hour, Day ... time **Job Shift:** Multiple shifts available **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT REMOTE **Address:** CA Mission Hills 15031 Rinaldi… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Part- time and will work 8-hour, Day ... Schedule:** Part time **Job Shift:** Day **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT REMOTE **Address:** CA Mission Hills 15031 Rinaldi St… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... benefits including a fresh perspective on workplace flexibility. NOTE: This is a fully remote role. Preference will be given to applicants who reside in Florida, who… more
- Texas Health Resources (Arlington, TX)
- Director Utilization Management-Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... Arlington, TX + Core work hours: Monday-Friday 8:00a-5:00p. This position is hybrid remote /onsite. Vast majority of time will be remote , but there will… more
