- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse I Department: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time) Schedule: ... Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act...on health system needs + Current New York State Registered Nurse License PREFERRED QUALIFICATIONS: +… more
- Katmai (Fort Carson, CO)
- …Red Cross. + Three (3) years within the last four (4) years as a registered nurse in utilization management . + One (1) year of experience in UR/UM and ... Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE...full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate… more
- Hartford HealthCare (Willimantic, CT)
- …* Registered Nurse Case Manager (RN) - Utilization Management * **Location:** *Connecticut-Willimantic-Windham Community Memorial (10183)* **Requisition ... the direction of the Manager of Continuing Care and Utilization Management and in collaboration with physicians,... experience preferred. *LICENSURE/CERTIFICATION* * Current license as a registered nurse in the State of Connecticut.… more
- Veterans Affairs, Veterans Health Administration (El Paso, TX)
- …throughout the continuum of care. Responsibilities The Community Care (CC) Coordinator Registered Nurse (RN) is responsible for executing a streamlined approach ... of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Utilization Management Full Time, 80 Hours Per Pay Period, Day Shifts Covenant Health Overview: Covenant Health is the region's ... Forbes "Best Employer" seven times. Position Summary: The RN Utilization Management I will perform utilization...management experience. Licensure Requirement: Current licensure as a Registered Nurse (RN) as issued by the… more
- Humana (Richmond, VA)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cedars-Sinai (Los Angeles, CA)
- …one of America's Best Hospitals. Summary of Essential Duties: + The Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent ... Eye/Hand/Foot Coordination **Req ID** : 14355 **Working Title** : Registered Nurse - Utilization Review Case...Review Case Manager - 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical… more
- UNC Health Care (Kinston, NC)
- …clinical experience as a Registered Nurse required. + 2 years utilization review, care management , or compliance experience preferred. + Minimum 1 year ... management preferred. + **LICENSURE/REGISTRATION/CERTIFICATION** + Licensed to practice as a Registered Nurse in the state of North Carolina. **Job Details**… more
- Cedars-Sinai (Los Angeles, CA)
- …necessity reviews with accepted criteria required **Req ID** : 14141 **Working Title** : Registered Nurse - Utilization Review Case Manager - PER DIEM ... - 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical Center **Job Category** : Patient Services **Job Specialty** :… more
- Actalent (Atlanta, GA)
- …PM (Rotating weekends) About the Role We are seeking a detail-oriented and compassionate Utilization Review Registered Nurse (RN) to join our team. In ... Job Title: Utilization Review RN Location: Buckhead, GA (on-site position)...and benefits as needed. + Identify patients for case management programs. + Participate in quality improvement initiatives. +… more
- Beth Israel Lahey Health (Burlington, MA)
- …weekends. This position is on-site at Lahey Hospital and Medical Center. The Utilization Analyst works with physicians, the payers and inpatient case management ... medical necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue integrity, these specialized case… more
- CVS Health (Austin, TX)
- …the department.** **Rotational late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical ... Clinical Social Worker (LCSW) preferred. + Requisition Job Description **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100%… more
- The County of Los Angeles (Los Angeles, CA)
- …ambulation may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience whose primary charge ... OPTION II: Two (2) years of experience as a registered nurse , of which one year must...County of Los Angeles, a Utilization Review Nurse is an RN that has Case Management… 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...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse (RN) - Active, current and… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- **12/2/2025 - REVISED FTE *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department for the/Emergency Department / ... needs and may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for… more
- CVS Health (Harrisburg, PA)
- …both verbal and written **Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care setting + Must have active ... current and unrestricted RN licensure in state of residence + Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and… more
- CVS Health (Austin, TX)
- …to work Monday through Friday, 10am to 7pm EST with occasional holiday rotation. Utilization Management is a 24/7 operation and work schedules will include ... **Required Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current...10:00am to 7:00pm eastern time with occasional holiday rotation. Utilization Management is a 24/7 operation and… more
- Sanford Health (Rapid City, SD)
- …providing direct supervision of all departmental staff. Maintains a standardization of utilization management process to ensure all policies and procedures are ... Hours:** 40.00 **Department Details** Join our team as a Utilization Review and Case Management Manager and...in medical necessity review preferred. Currently holds an unencumbered registered nurse (RN) license with the State… more
- US Tech Solutions (Hopewell, NJ)
- …**Additional licensing, certifications, registrations:** 1. Requires an active New Jersey Registered Nurse License. **Knowledge:** - Prefers proficiency in the ... management principles. - Prefers working knowledge of principles of utilization management . - Prefers basic knowledge of health care contracts and benefit… more
- George C. Grape Community Hospital (Hamburg, IA)
- …* Education & Collaboration: o Educate clinical staff on documentation requirements, utilization management processes, and infection control standards. o Serve ... control, and payers to resolve care coordination issues. Qualifications: * Education: Registered Nurse (RN) license required; BSN preferred. * Experience: o… more
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