- 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 ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied… 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 ... services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied… more
- The County of Los Angeles (Los Angeles, CA)
- …ambulation may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience whose primary charge ... or Medical Service Coordinator, CCS.** -OR- OPTION II: Two ( 2 ) years of experience as a registered nurse...County of Los Angeles, a Utilization Review Nurse is an RN that has Case Management… 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 ... service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has...CCM (Certified Case Manager) **Required Experience (must have):** + 2 to 3 years Utilization Management… more
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- Summary The Utilization Management (UM) Registered Nurse ...nursing experience in which one year is equivalent to Nurse I, Level 2 ; OR a BSN and ... accreditation standards, and performance measures. Uses emergency and bed management software and utilization data to manage...1 year of professional nursing experience equivalent to the Nurse I, Level 2 ; OR a Master's… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Medical...requested authorizations. Refer patients to case management nurse or health coach as appropriate. 2 . ... On 06/05/2025 **Job Overview** **Description** Medical Associates is looking for a ** Utilization Management Nurse ** to join our Health Care Services team!… more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- Summary The Utilization Management (UM) Consultant is a registered...nursing experience in which one year is equivalent to Nurse I, Level 2 ; OR a BSN and ... services, administrative officers, Emergency Department (ED) staff, and Bed Management . The nurse is responsible for applying...1 year of professional nursing experience equivalent to the Nurse I, Level 2 ; OR a Master's… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN...clinical experience in an acute hospital setting. At least 2 years of Utilization Management /Case ... nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get...net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN… more
- Elevance Health (Morgantown, WV)
- RN Utilization Management /Review Nurse -... management experience and requires a minimum of 2 years clinical, utilization review, or managed ... **Work Hours** : Monday through Friday, 8am - 5pm The **Medical Management Nurse ** (Medicaid Utilization Review) is responsible for review of the… more
- CVS Health (Olympia, WA)
- …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 pacific time zones… 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
- McLaren Health Care (Pontiac, MI)
- …requirements _Preferred:_ + Bachelor's degree in nursing + Experience in utilization management /case management /clinical documentation, critical care, or ... **Position Summary:** Responsible for Utilization and Care Management services to...OBV, OP). Sends accounts to secondary reviewer as necessary. 2 . Provides guidance to providers and clinical staff regarding… more
- Katmai (Fort Carson, CO)
- …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
- Elevance Health (Woodbridge, VA)
- … management or case management experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination ... is located at 609 H. Street NE. The **Medical Management Nurse ** is responsible for review of...the District of Columbia is required. **Preferred Qualifications:** + Utilization Management /Review in managed care strongly preferred.… more
- CDPHP (Albany, NY)
- …care experience is required as a Registered Nurse . + Minimum of two ( 2 ) years Utilization Management experience is preferred. + Knowledge of ... you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for...transportation, DME requests and inpatient readmissions. In collaboration with management , the UR nurse identifies potentially high-cost… more
- R1 RCM (Detroit, MI)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our hospital ... you must have experience in a clinical inpatient environment and hospital-based utilization or case management experience. Proficiency in basic computer skills… more
- Prime Healthcare (Weslaco, TX)
- …Criteria preferred. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/210205/registered- nurse -case-manager utilization - management ... in a related field. At least one year experience in case management , discharge planning or nursing management ; 2 . CCM or obtained within 6 months of hire.3.… 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 ... prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. +… more
- Dignity Health (Mesa, AZ)
- **Responsibilities** Under the general direction of the Director of Care Management , performs criteria-based concurrent and retrospective utilization review to ... use of resources; promote quality patient care; assist with patient care management ; comply with applicable standards and regulations and provide information and… more
- Prime Healthcare (Ontario, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/176615/ utilization -review- nurse -lvn/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... 360 outpatient locations in 14 states providing more than 2 .5 million patient visits annually. It is one of...Minimum two years of experience in acute hospital case management or equivalent. + Utilization Management… more