- Humana (Charleston, WV)
- …interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 - Onsite Nurse located at the ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes...determination of the appropriate courses of action at an onsite facility. This hybrid position will have limited hours… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Medical Associates**... Nurse MercyOne RN - Float Pool Registered Nurse MercyOne RN - Onsite Virtual Registered ... On 06/05/2025 **Job Overview** **Description** Medical Associates is looking for a ** Utilization Management Nurse ** to join our Health Care Services team!… 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.** ... : Monday through Friday, 8am - 5pm The **Medical Management Nurse ** (Medicaid Utilization Review)...times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring… more
- Humana (Louisville, KY)
- …of the appropriate courses of action. The Utilization Management Nurse 2 will work both telephonically and onsite , interacting with providers and ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… 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
- Elevance Health (Woodbridge, VA)
- …and adaptable workplace. The office is located at 609 H. Street NE. The **Medical Management Nurse ** is responsible for review of the most complex or challenging ... RN Utilization Review Nurse (Washington DC Medicaid)...the District of Columbia is required. **Preferred Qualifications:** + Utilization Management /Review in managed care strongly preferred.… 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 4 years ... interviews on ms teams will be required to be onsite for the 1st week and then will be...effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is… 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
- UNC Health Care (Kinston, NC)
- …and well-being of the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care is provided ... the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of...Health Entity: UNC Lenoir Health Care Organization Unit: Care Management Work Type: Full Time Standard Hours Per Week:… more
- ChenMed (North Miami Beach, FL)
- …years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning experience ... expanding and we need great people to join our team. The Acute Care Nurse (RN) is responsible for achieving positive patient outcomes and managing quality of care… more
- WellSpan Health (Gettysburg, PA)
- …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... serves as a nursing resource for clinical staff. Position may be onsite , hybrid or remote. **Duties and Responsibilities** **Essential Functions:** + Obtains patient… more
- Trinity Health (Mishawaka, IN)
- …This is NOT a remote position.** **_About the job:_** The licensed Registered Nurse (RN) plans & provides professional nursing services & standards of practice in ... & Stewardship:** Incorporates caring process (Caritas), advocacy & appropriate resource utilization as an essential component of nursing practice through concrete… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in ... of three years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated… more
- UNC Health Care (Raleigh, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... of UNC Health._ _We are currently seeking an experienced nurse to join our dynamic team as an RN...management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization… more
- Mount Sinai Health System (New York, NY)
- …and efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management , care facilitation and ... field, Master's degree preferred + 5 years of Case Management and 6 years as a clinical nurse... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West… more
- Elevance Health (San Antonio, TX)
- …and personalized support throughout the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior Authorization **Location:** ... immediate support. **Build the Possibilities. Make an extraordinary impact.** The ** Utilization Management Representative II - Prior Authorization** is… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …safe discharge coverage for all hospital units. + Participates in utilization management initiatives/opportunities for improvement through departmental committee ... Onsite Position Position Purpose: Works in partnership with...Florida. + 3 years minimum experience in discharge planning, utilization management , or case management .… more
- Elevance Health (Latham, NY)
- ** Utilization Management Representative I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... integration, and ensures essential face-to-face onboarding and skill development. The ** Utilization Management Representative I** will be responsible for… more
- Elevance Health (Tampa, FL)
- ** Utilization Management Representative I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... integration, and ensures essential face-to-face onboarding and skill development. The ** Utilization Management Representative I** will be responsible for… more
- ERP International (Luke AFB, AZ)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with ... **Overview** ERP International is seeking full time **Registered Nurse - Case Management ** in support of the56th Medical Group at Luke AFB, AZ… more