- Actalent (Sunrise, FL)
- Actalent is hiring UM nurses!Job Description The Utilization Management Nurse (UMN) plays a crucial role in optimizing the utilization of healthcare ... on department activities. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Medical Associates** 1 Positions ID: oQ7fwfws Posted On 06/05/2025 **Job Overview** **Description** Medical Associates is ... looking for a ** Utilization Management Nurse ** to join our Health Care Services team! **Schedule:** Primary schedule will be Monday through Friday 8:00am to… 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 ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- CVS Health (Little Rock, AR)
- …and work schedules will include weekends, holidays, and evening hours As a Utilization Management Nurse Consultant, you will utilize clinical skills ... Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN...to 7pm in time zone of work being supported. Utilization management is a 24/7 operation. Work… more
- Actalent (Des Moines, IA)
- Job Title: Utilization Management Nurse Job Description **Must reside in Iowa or South Dakota** The Utilization Management Nurse is responsible ... with providers to resolve utilization review issues. + Process utilization management requests using clinical knowledge and expertise. + Collaborate… more
- Actalent (Des Moines, IA)
- Utilization Management Nurse - Job Description**Must reside in Iowa or South Dakota** This role involves providing members and healthcare providers with ... quality assurance and production metrics as established for the utilization management unit. Essential Skills + Registered Nurse (RN) or Licensed Practical… more
- Humana (Charleston, WV)
- **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
- Humana (Louisville, KY)
- **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/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied and… more
- Elevance Health (Morgantown, WV)
- RN Utilization Management /Review Nurse - InPatient Medicaid (JR155056) **Location:** This position requires you to **reside in the state of West Virginia.** ... **Work Hours** : Monday through Friday, 8am - 5pm The **Medical Management Nurse ** (Medicaid Utilization Review) is responsible for review of the… 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 CCA… more
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- Summary The Utilization Management (UM) Registered Nurse (RN) is responsible for UM reviews for patients who receive hospital care. Responsibilities An UM ... Registered Nurse is responsible for UM reviews and use of...accreditation standards, and performance measures. Uses emergency and bed management software and utilization data to manage… more
- Aspen Medical (Aurora, CO)
- JOB AD: Registered Nurse - Utilization Management Introduction : Aspen Medical has an exciting opportunity for Registered Nurses to partner with us in ... Case Management through the American Nurses Credentialing Center or Utilization Management Accreditation through National Committee for Quality Assurance… more
- WellSpan Health (York, PA)
- …effective and quality health care. Provides leadership in the integration of utilization management principles throughout the System. Responsible for screening ... analysis as required. + Develops and initiates educational programs regarding utilization management principles. + Attends meetings as required.… more
- CVS Health (Annapolis, MD)
- …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 ET and CT time zones,… more
- CVS Health (Raleigh, NC)
- …to work Monday through Friday, 9:00am to 5:30pm EST with occasional holiday rotation. Utilization Management is a 24/7 operation and work schedules will include ... holidays and evening hours **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience + Experience using… more
- Actalent (Sunrise, FL)
- Utilization Management Behavioral Health ClinicianUtilization Management Behavioral Health Clinician We're seeking a dedicated Behavioral Health Clinician to ... join our Utilization Management team. In this role, you'll collaborate with an interdisciplinary team to review and authorize behavioral health and substance use… more
- Signature Healthcare (Louisville, KY)
- …communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses. + Coordinate internal and external health ... What you Need to make a Difference + Registered Nurse (RN) in good standing with required current state...Previous experience with MDS and assessment preferred Hospital Case Management /Hospital Utilization Management . Obtaining… more
- Katmai (Fort Carson, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... licensed in Colorado, be able to practice using a nurse compact state license or have a license from...checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional… more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- Summary The Utilization Management (UM) Consultant is a registered professional nurse , qualified by education and experience to work directly with ... clerks, social services, administrative officers, Emergency Department (ED) staff, and Bed Management . The nurse is responsible for applying clinical skills in… 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