- Humana (Charleston, WV)
- …interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 - Onsite Nurse located at the ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes...determination of the appropriate courses of action at an onsite facility. This hybrid position will have limited hours… 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 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review, and collaborates with … more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse (UMN) collaborates closely with the ... activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management ...between 2-4 weeks, with opportunities to shadow team members onsite and through Teams. Pay and Benefits The pay… 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 subsidiary of ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- Dignity Health (Carmichael, CA)
- **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite Campus Position** The ** Utilization Review RN** is responsible for the ... 1 year experience. + Current CA RN licensure + ** Onsite Campus position** **Preferred:** + Bachelor's Degree in Nursing...to be successful in the role:** + Understand how utilization management and case management … more
- UNC Health Care (Kinston, NC)
- …and well-being of the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care is provided ... the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of...Health Entity: UNC Lenoir Health Care Organization Unit: Care Management Work Type: Full Time Standard Hours Per Week:… more
- ChenMed (North Miami Beach, FL)
- …years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning experience ... expanding and we need great people to join our team. The Acute Care Nurse (RN) is responsible for achieving positive patient outcomes and managing quality of care… more
- Access Dubuque (Dubuque, IA)
- …& Butler/ SISCO** 1 Positions ID: 4823670008 Posted On 07/29/2025 **Job Overview** ** Utilization Management CNA** **Location** : Onsite in Dubuque, IA. ... a fast-paced, professional environment? We are seeking a dedicated ** Utilization Management CNA** to join our healthcare...Nurse Aide (2p-10p, PT) Sisters of the Presentation Utilization Management Assistant Cottingham & Butler/ SISCO… more
- WellSpan Health (Gettysburg, PA)
- …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... serves as a nursing resource for clinical staff. Position may be onsite , hybrid or remote. **Duties and Responsibilities** **Essential Functions:** + Obtains patient… more
- UNC Health Care (Chapel Hill, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... case management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization management… more
- Children's Hospital Boston (Boston, MA)
- …Posting Title:Per Diem RN Case Manager, Utilization Management /ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard ... + Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current Massachusetts license… more
- Elevance Health (Miami, FL)
- ** Utilization Management Representative II** **Location:** This role enables associates to work virtually full-time in **Florida** , with the exception of ... 6 am - 6 pm EST including weekends. The ** Utilization Management Representative II** is responsible for...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Elevance Health (Louisville, KY)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... accommodation is granted as required by law._ " The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- UNC Health Care (Hendersonville, NC)
- …management referrals. Initiates appropriate social work referrals. + Performs utilization management assessments and interventions, using collaboration with ... well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and...Management Work Type: Per Diem Work Assignment Type: Onsite Work Schedule: Day Job Location of Job: PARDEEHOSP… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... To provide leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal management and development… more
- Elevance Health (Miami, FL)
- **Medical Management Nurse ** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... - 6pm EST and will include weekends. The **Medical Management Nurse ** will be responsible for review...experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination… more
- ChenMed (St. Louis, MO)
- …years' clinical work experience required + A minimum of 1 year of utilization review and/or case management , home health, discharge planning experience required ... great people to join our team. The Acute Care Nurse (ACN) is responsible for achieving positive patient outcomes....by either the RN or LPN include: + Conducts utilization view for appropriate utilization of services… more
- ERP International (Yuma, AZ)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with ... databases for community resources, etc. + Integrate CM and utilization management (UM) and integrate nursing case...the certifications below **OR** Possess a Master's Degree in Nurse Case Management from a program accredited… more
- Veterans Affairs, Veterans Health Administration (New York, NY)
- Summary The Interventional Radiology Registered Nurse is responsible for providing competent, evidence-based care to assigned patients and oversight of licensed ... assistants, as appropriate to the setting. Responsibilities Duties include: The nurse will assist in directing the provision of nursing education, orientation,… more
- Elevance Health (Nashville, TN)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... ** Nurse Reviewer I** **Location:** **Virtual:** This role enables...RN license in applicable state(s) required. + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more