- Humana (Jackson, MS)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Austin, TX)
- …9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... of healthcare resources. Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of healthcare… more
- Houston Methodist (Houston, TX)
- …of hospital clinical nursing experience, which includes three years in utilization review and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position...to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of… more
- Katmai (Fort Carson, CO)
- …American 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 ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the CMHS.… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring… more
- CVS Health (Columbus, OH)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active current ... on the telephone, and type on the computer. **Preferred Qualifications** Utilization Management experience preferred **Education** Diploma RN acceptable;… more
- McLaren Health Care (Port Huron, MI)
- …with an acute care hospital **Preferred:** ⦁ Experience in utilization management /case management , critical care, clinical documentation, or patient ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- Actalent (Minnetonka, MN)
- Utilization Management Nurse Job...or bachelor's degree in nursing. + 3-5+ years of clinical experience. + Previous utilization management ... Description As a Utilization Management Nurse for Post Acute care, you will be responsible...history in compliance with established policies and procedures, applying clinical criteria and member coverage. This role involves interfacing… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests ... member's benefit coverage while working remotely. Primary Responsibilities * Performs clinical utilization reviews using evidenced based guidelines, policies 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 / ... utilization and controlling costs./**/ *Assessment:* * Collects, reviews, and documents clinical data relevant to utilization management , including… more
- CVS Health (Trenton, NJ)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in EST zones **Education**… more
- CVS Health (Harrisburg, PA)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active current ... Nursing Licenses as business needs require. * **Preferred Qualifications** - Utilization Management experience preferred **Education** Associates Degree BSN… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Cottingham & Butler/ SISCO** 1 Positions ID: 4627707008 Posted On 07/01/2025 Refreshed On 11/23/2025 **Job Overview** ** ... Utilization Management Nurse ** **Location** :...Qualified candidates will have strong multitasking skills, RN and clinical experience, preferably in ER, ICU, mental health, orthopedics,… more
- CVS Health (Lansing, MI)
- …**Position Summary** Join our Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria to ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- CVS Health (Hartford, CT)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active current ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma… more
- CVS Health (Columbus, OH)
- …a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, ... initiate a Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners... clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management… more
- Saint Francis Health System (OK)
- …their placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers ... not all inclusive nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location: Virtual Office, Oklahoma 73105… more
- CVS Health (Phoenix, AZ)
- …that promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. ... In this role, you'll be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to...a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM… more
- CVS Health (Austin, TX)
- … clinical experience in acute or post-acute setting,and 1+ years of Utilization Management / CareManagementExperience + Must have active current and ... obtainadditionalNursing Licenses as business needsrequire. * **Preferred Qualifications** - Utilization Management experience preferred - **Anticipated Weekly… more
- Emory Healthcare/Emory University (Decatur, GA)
- …development _,_ and leadership programs + And more **Description** We're seeking a ** Clinical Utilization Review Nurse Preceptor (Registered Nurse ... be regarded as a clinical expert, leader, and role model within the Utilization Review Department as it relates to the understanding and application of the … more