• Utilization Management

    Humana (Olympia, WA)
    **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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… more
    Humana (11/12/25)
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  • RN UM Clinical Appeals Nurse Remote

    Molina Healthcare (Tacoma, WA)
    …be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and member/provider inquiries/ appeals . * Provides ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
    Molina Healthcare (11/14/25)
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  • Utilization Review RN

    Swedish Health Services (Seattle, WA)
    …strong clinical background blended with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. ... education and training for staff and other health care providers regarding utilization management process, including but not limited to: reimbursement patterns,… more
    Swedish Health Services (11/06/25)
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  • Medical Review Nurse (RN)

    Molina Healthcare (WA)
    …decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/ appeals . + Provides training and ... ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS)… more
    Molina Healthcare (09/06/25)
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  • Medical Director (NV)

    Molina Healthcare (WA)
    …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
    Molina Healthcare (10/31/25)
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  • Medical Director (AZ)

    Molina Healthcare (Everett, WA)
    … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the...analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory,… more
    Molina Healthcare (10/17/25)
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  • Clinical Program Coordinator RN, Medicare…

    Providence (WA)
    …of Care Planning, Discharge Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review, Prior Authorization, Medical ... are terminal and nearing end of life + Care management services include: nurse education, care coordination...Audits, Appeals or Delegation) + Experience working in a health… more
    Providence (10/24/25)
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  • RN Care Review Clinician Remote

    Molina Healthcare (Tacoma, WA)
    …to provide quality and cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
    Molina Healthcare (11/09/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (Vancouver, WA)
    …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job… more
    Molina Healthcare (11/01/25)
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