- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Aug 22, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling ... care and their communities. Role Overview: The role of Utilization Management Manager oversees the...and clinical criteria evaluations.They will possess a current unrestricted RN license from the State of Indiana; a minimum… more
- CVS Health (Charleston, WV)
- …years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals experience in Utilization ... **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development and… more
- CVS Health (Little Rock, AR)
- …**Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development and ... needed. + 3+ years inpatient clinical experience as a Registered Nurse . + 3+ years of Managed...years of Managed Care experience. + 3+ years of Utilization Management experience. + 1+ year Leadership… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... **Join Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff… more
- CVS Health (Oklahoma City, OK)
- …+ 5+ years of clinical practice experience in behavioral healthcare + 2+ years utilization management experience is required + 2+ years of experience with ... we do it all with heart, each and every day. **Position Summary** The Manager , UM Clinical Services, conducts oversight and management of clinical team processes… more
- Centene Corporation (Phoenix, AZ)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... care to members. Oversees and works with senior leadership on utilization management issues related to member care, provider interactions, and facilitates… 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
- UNC Health Care (Smithfield, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection...date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North… more
- Guthrie (Sayre, PA)
- …approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of ... degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant...admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b.… more
- Healthfirst (NV)
- The Case Manager , Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge ... and case management as assigned. The Case Manager , Utilization Management is also...necessary + Additional duties as assigned Minimum Qualifications: + RN , LPN, LMSW, LMHC, LMFT, LCSW, PT, OT, and/or… more
- Trinity Health (Chelsea, MI)
- …**Shift:** Rotating Shift **Description:** ** Registered Nurse ** **Case Manager ** **Department:** Utilization Management **Location:** Chelsea, MI ... **Minimum pay rate:** $38.77-52.32/hr + based upon RN license date and applicable experience **Why Join Us?**...+ Tuition Reimbursement **Position Purpose:** Exceptional opportunity for a Registered Nurse Case Manager to… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** RN Manager - Case Management & Utilization Management ** **Location:** Holy ... is seeking a dynamic and experienced ** RN Manager - Case Management & Utilization...and care coordination. **Minimum Qualifications** + **Licensure/Certification:** + Active Registered Nurse license in the State of… more
- LA Care Health Plan (Los Angeles, CA)
- …Licensed Clinical Social Worker (LCSW); Current and unrestricted California License or Registered Nurse ( RN ); current and unrestrited California License. ... Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The… more
- Ellis Medicine (Schenectady, NY)
- …is to work with the Social Worker, Nurse Case Manager , or Utilization Management Nurse to facilitate patient discharge plans, support coordination of ... care activities, and assist in utilization management activities under the direction of a registered... management activities under the direction of a registered nurse and/or social worker. Responsibilities include… more
- UPMC (Pittsburgh, PA)
- Are you a registered nurse with a background in utilization management ? Are you interested in the opportunity to work from home? UPMC Health Plan is ... looking for you! We are hiring a full-time Utilization Management Care Manager to...management certification or approved clinical certification preferred + Registered Nurse ( RN ) *Current licensure… more
- Texas Health Resources (Arlington, TX)
- Registered Nurse ( RN ) - Case Manager - PRN Work location: Texas Health Arlington 800 W. Randol Mill Road TX 76012 Work hours: PRN - Weekend/Evening Shift ... utilization review Req 1 Year of acute case management /discharge planning experience Pref Licenses and Certifications RN - Registered Nurse Upon Hire… more
- HCA Healthcare (Webster, TX)
- …Lake we support our colleagues in their positions. Join our Team as a(an) Registered Nurse RN Case Manager PRN and access programs to assist with every ... job skills. Apply today for our Registered Nurse RN Case Manager PRN...utilization **What qualifications you will need:** + Current Registered Nurse License in the State of… more
- HCA Healthcare (Richmond, VA)
- …at Chippenham Hospital have the opportunity to make a real impact. As a ** Registered Nurse RN Case Manager ** you can be a part of change. Currently ... outcomes for your patients as a ** Registered Nurse RN Case Manager ** ....experience in a hospital setting preferred. + Previous case management or utilization review experience preferred. Chippenham… more
- Mayo Clinic (Rochester, MN)
- …rounds and collaborates to potentially impact length of stay. The Registered Nurse ( RN ) Case Manager works within an interdisciplinary team to ... utilization management , care coordination, resource utilization , and clinical documentation. The RN Case... Manager provides leadership through education on case management / utilization management concepts, committee work,… more
- HCA Healthcare (Tomball, TX)
- …we support our colleagues in their positions. Join our Team as a(an) Registered Nurse RN Case Manager and access programs to assist with every stage ... job skills. Apply today for our Registered Nurse RN Case Manager opening...utilization **What Qualifications you will need:** + Current RN License in the State of Texas or Multi-State… more
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