- VitalCore Health Strategies (Hopkinton, MA)
- …Insurance Employee Assistance Program and Discount Center 401K EEO Keywords: Utilization Management , RN, Nurse , Administrative, #INDMA Compensation ... in Correctional Healthcare, has a Full-Time opening for a Utilization Management RN at the Regional Office...treatment plans as indicated by patients' responses and conditions Review all aspects of facility patient care Review… more
- California Practice Staff (Modesto, CA)
- …and staffing Assists the physician as follows, but not limited to Utilization Review , Quality Assurance, Program Evaluation, Infection Control, Safety Committee ... of laboratory tests as part of the physical examination and health management . Perform and oversee testing and other appropriate procedures. Conducts health teaching… more
- University Health (San Antonio, TX)
- …Three years recent, full time hospital experience preferred. Work experience in case management , utilization review , or hospital quality assurance experience ... and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to… more
- University of New Mexico - Hospitals (Albuquerque, NM)
- …to experience, education, and other business and organizational considerations.Department: Utilization Management - UHFTE: 1.00Full TimeShift: DaysPosition ... patient responses to interventions in collaboration with quality assurance and utilization review , maintaining interdependent follow-up as necessary* VARIANCE -… more
- The Laurels of Fulton (St. Johns, MI)
- …assessments and care plan coordination for guests. The MDS Coordinator supervises the Care Management Nurse , MDS Nurse . The Laurels of Fulton offers one ... Are you an experienced MDS nurse interested in the next step? The MDS...PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management… more
- The Laurels of Fulton (Chesaning, MI)
- …assessments and care plan coordination for guests. The MDS Coordinator supervises the Care Management Nurse , MDS Nurse .The Laurels of Fulton offers one of ... Are you an experienced MDS nurse interested in the next step? The MDS...PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management… more
- University Health (Hondo, TX)
- …Three years recent, full-time hospital experience preferred. Work experience in case management , utilization review or hospital quality assurance experience ... hire date. LICENSURE/CERTIFICATION Current license from the Board of Nurse Examiners of the State of Texas to practice...the State of Texas to practice as a registered nurse is required. National certification in related field is… more
- VitalCore Health Strategies (Munising, MI)
- …clinical quality and integrity of patient medical care including oversight of utilization and quality management , credentialing, and best practice guideline ... managed healthcare systems, medical quality assurance, quality improvement and risk management is required Must have experience in launching and managing innovative… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based ... to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards,...+ A minimum of three years of experience in utilization management , preferred + Team leading or… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of ... hospital clinical nursing experience, which includes three years in utilization review and/or case management ...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 251212-5613FP-001 Location East Hartford, CT Date Opened 12/16/2025 12:00:00 AM ... to learn more about joining our team as a Utilization Review Nurse Coordinator! The...types of case reviews for quality and appropriate medical management , cost containment, peer review and rehabilitation;… 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
- Catholic Health (Kenmore, NY)
- …and families in the hospital setting. Utilizing foundational nursing clinical skills Utilization Review nurse collaborates with the interdisciplinary team ... Rotation Hours: 8 am- 4 pm Summary: The Registered Nurse (RN), Utilization Review , as...in an Acute Care Hospital Setting + Proficiency in utilization management and regulatory requirements preferred +… more
- George C. Grape Community Hospital (Hamburg, IA)
- Quality/ Utilization Review Nurse Position Summary: The Quality/ Utilization Review Nurse is responsible for evaluating the medical necessity, ... years of clinical nursing experience (acute care preferred). o Prior experience in utilization review , case management , quality improvement, and infection… more
- Huron Consulting Group (Chicago, IL)
- … Utilization Review Plan and the overall operation of the Utilization Management Department in accordance with federal, state and local guidelines, ... are now and create your future. The Manager of Utilization Management is responsible for planning, organizing,...+ Staff Acquisition and Support: Leads and manages the utilization review staff and function for the… 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
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** ... + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the ... standards for appropriate utilization of services. Perform utilization management / review for medical necessity...within the last four (4) years as a registered nurse in utilization management . +… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use...as an RN, preferably in a hospital setting + Utilization management experience in a health plan… more
- Albany Medical Center (Albany, NY)
- …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions… more
