• RN Utilization Manager - UNC…

    UNC Health Care (Raleigh, NC)
    …_We are currently seeking an experienced nurse to join our dynamic team as an RN Utilization Manager . Role is full time, 40 hours per week, on site._ ... care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management… more
    UNC Health Care (06/03/25)
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  • Utilization Manager

    Gentiva (Mooresville, NC)
    …a lasting difference in people's lives every day. **Overview** We're looking for a ** Utilization Manager ** to join our team. This position will directly report ... to the Director of Utilization Management and is responsible for planning, coordinating, implementing,...a Remote position with travel expectations. **About You** + Registered Nurse preferred + Bachelor's degree preferred… more
    Gentiva (05/31/25)
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  • Manager Utilization Management…

    Tufts Medicine (Burlington, MA)
    …minimizing cost, and ensuring optimum outcomes. **Job Description** **Minimum Qualifications:** 1. Registered Nurse (BSN or higher) or other licensed clinical ... assisting with the coordination of the Utilization Management Committee. The Utilization Management Operations Manager follows the system's Utilization more
    Tufts Medicine (06/01/25)
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  • Manager , Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    …procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing the ... daily operation of the Utilization Management Review Nurse and Specialist staff...decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director… more
    Commonwealth Care Alliance (05/21/25)
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  • RN Case Manager - Utilization

    Trinity Health (Silver Spring, MD)
    **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time ... : Holy Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management, you will be...resource for navigating post-acute care services. **Minimum Qualifications:** + RN licensed by the State of Maryland or Compact… more
    Trinity Health (05/13/25)
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  • Utilization Review Case Manager

    Dartmouth Health (White River Junction, VT)
    … – Home Health PRN, Days Why work as a Utilization Review Case Manager at Visiting Nurse and Hospice for Vermont and New Hampshire? * You experience ... one 4-hour flex shift to be discussed with hiring manager . Locations: * Fully remote work in all statesexcept:...CT, MA, MD, NJ, NY, OH, RI, WY. Visiting Nurse and Hospice for VT & NH covers more… more
    Dartmouth Health (06/06/25)
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  • Utilization Mgmt Case Manager FT

    LifePoint Health (Gallatin, TN)
    …or related healthcare field. **Job:** **Nursing* **Organization:** ** **Title:** * Utilization Mgmt Case Manager FT* **Location:** *Tennessee-Gallatin* ... Monitors adherence to the hospital's utilization review plan to ensure appropriate use of...- Case Management Minimum Education Associate's, Bachelor's degree or RN Diploma in Nursing - Required Required Skills Requires… more
    LifePoint Health (04/28/25)
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  • Case Manager Utilization Review…

    Beth Israel Lahey Health (Burlington, MA)
    Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse ( RN ) Case Manager for Hospital at Home Care Transitions coordinates ... to meet the needs of the department. **Minimum Qualifications:** Education: * Registered Nurse , Bachelors Degree or commensurate experience preferred. Licensure,… more
    Beth Israel Lahey Health (05/11/25)
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  • Manager - Utilization Review…

    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 We ... Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance… more
    Beth Israel Lahey Health (04/29/25)
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  • Case Manager and Utilization Review…

    Scottish Rite for Children (Dallas, TX)
    …committed to giving children back their childhood! Job Posting Title: Case Manager and Utilization Review Coordinator Location: Dallas - Hospital Additional ... + Maintain effective communication with patient care team members related to utilization management + Verify medical necessity of all Inpatients using established… more
    Scottish Rite for Children (05/23/25)
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  • Utilization Manager RN

    Central Maine Medical Center (Lewiston, ME)
    …for our community and for each other every day. Position Summary: The Utilization Management Nurse is responsible for a comprehensive clinical review to ... RN licensure.*Three (3) or more years of previous experience in Utilization Management and/or Care Management.*BSN preferred.Certified Case manager required… more
    Central Maine Medical Center (05/29/25)
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  • Hospital Reviewer/ Utilization

    DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
    …initiatives/opportunities for improvement through departmental committee assignments. Qualifications: + Registered Nurse or Licensed Practical Nurse . ... healthcare needs of the patients using the functions of Utilization Resource Management, Transition of Care, Discharge Planning, and...+ Current and valid license to practice as a Registered Nurse or Licensed Practical Nurse more
    DOCTORS HEALTHCARE PLANS, INC. (05/30/25)
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  • Interim RN Utilization Review…

    Ascension Health (Baltimore, MD)
    …job transfer date required. American Heart Association or American Red Cross accepted. + Registered Nurse obtained prior to hire date or job transfer date ... required. Education: + Required professional licensure/certification AND 3 years of experience and 1 year of cumulative leadership experience required. **Additional Preferences** \#ATP **Why Join Our Team** Ascension associates are key to our commitment of… more
    Ascension Health (04/24/25)
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  • Registered Nurse Case Manager

    Prime Healthcare (Weslaco, TX)
    …and InterQual Criteria preferred. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/210205/ registered - nurse -case- manager utilization ... -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityKnapp Medical Center LocationUS-TX-Weslaco ID2025-210205 CategoryClinical Professional Position TypeFull Time ShiftDays Job TypeNon-Exempt more
    Prime Healthcare (06/06/25)
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  • Manager Utilization Management

    Beth Israel Lahey Health (Burlington, MA)
    …Degree, Master's Degree preferred **Licensure, Certification, Registration:** Current license as a Registered Nurse **Skills, Knowledge & Abilities** : + Current ... a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for determining… more
    Beth Israel Lahey Health (06/06/25)
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  • RN Manager - Utilization

    Ascension Health (Pensacola, FL)
    …evaluation of staff. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Florida Department of Health ... **Details** + **Department: Utilization Review** + **Schedule: Full time days** +...at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… more
    Ascension Health (06/04/25)
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  • Manager , Utilization Management

    Healthfirst (IA)
    …as assigned **Minimum Qualifications:** + Associates degree + New York State Registered Nurse + Work experience demonstrating verbal and written communication ... **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related...Excel, Word, Power Point and Outlook **Preferred Qualifications:** + RN , LPN, LMSW, LMHC, LCSW, or any other relevant… more
    Healthfirst (06/11/25)
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  • Nurse Utilization Management…

    Commonwealth Care Alliance (Boston, MA)
    013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring… more
    Commonwealth Care Alliance (05/23/25)
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  • Manager - Utilization Review

    Ochsner Health (Lafayette, LA)
    …medical management, or other related MCO departments/functions. **Certifications** Required - Current registered nurse ( RN ) license in state of practice. ... *MSW accepted in lieu of registered nurse ( RN ) licensure. Preferred - Certification in Case Management (CCM) or Certified Professional in Healthcare… more
    Ochsner Health (05/31/25)
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  • Case Manager , RN

    Prime Healthcare (Lynwood, CA)
    …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209331/case- manager %2c- rn utilization ... an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute… more
    Prime Healthcare (06/11/25)
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