- 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
- Humana (Tallahassee, FL)
- **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 ... and communication of medical services, discharges and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Access Dubuque (Dubuque, IA)
- …SISCO** 1 Positions ID: 4627707008 Posted On 07/01/2025 **Job Overview** ** Utilization Management Nurse ** **Location** : Onsite in Dubuque, IA. Also ... Utilization Management Nurse **Cottingham &...(RN) Senior Care MercyOne RN - Float Pool Registered Nurse MercyOne RN - Onsite Virtual Registered … 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
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management /clinical/or combination; 2 of 4 years ... interviews on ms teams will be required to be onsite for the 1st week and then will be...effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is… 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
- UNC Health Care (Raleigh, 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
- Access Dubuque (Dubuque, IA)
- …& Butler/ SISCO** 1 Positions ID: 4755768008 Posted On 07/01/2025 **Job Overview** ** Utilization Management Assistant** **Location** : Onsite in Dubuque, IA. ... a fast-paced, professional environment? We are seeking a dedicated ** Utilization Management Assistant** to join our healthcare...will also triage the call to determine if a Utilization Review Nurse is needed to complete… 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
- Trinity Health (Mishawaka, IN)
- …This is NOT a remote position.** **_About the job:_** The licensed Registered Nurse (RN) plans & provides professional nursing services & standards of practice in ... & Stewardship:** Incorporates caring process (Caritas), advocacy & appropriate resource utilization as an essential component of nursing practice through concrete… more
- CVS Health (Columbus, OH)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is ... external constituents in the coordination and administration of the utilization /benefit management function **Required Qualifications** + Licensed independent… more
- Mount Sinai Health System (New York, NY)
- …and efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management , care facilitation and ... field, Master's degree preferred + 5 years of Case Management and 6 years as a clinical nurse... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West… 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 (San Antonio, TX)
- …and personalized support throughout the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior Authorization **Location:** ... immediate support. **Build the Possibilities. Make an extraordinary impact.** The ** Utilization Management Representative II - Prior Authorization** is… 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 (Latham, NY)
- ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... integration, and ensures essential face-to-face onboarding and skill development. The ** Utilization Management Representative II** is responsible for managing… 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