- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Battelle Memorial Institute (Fort Benning, GA)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support...model allows you to work 60% in-office and 40% remote , with Monday and Tuesday as common in-office days,… more
- Battelle Memorial Institute (Columbus, OH)
- …+ Under the supervision of a licensed psychiatrist, social worker, psychiatric nurse or psychologist, responsible for providing a wide range of behavioral health ... program policy + Coordinate attendance and agenda at Case Review Committee with military and civilian agencies + Coordinate...model allows you to work 60% in-office and 40% remote , with Monday and Tuesday as common in-office days,… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… more
- CVS Health (Phoenix, AZ)
- …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 ... times may vary based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc....intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or… more
- Cognizant (Annapolis, MD)
- …Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
- Actalent (Atlanta, GA)
- Utilization Review - Registered Nurse Job Description This role involves performing precertification and medical necessity reviews for designated referrals ... - Appeals, and Risk Management. Essential Skills + Registered Nurse (RN) with a valid license in GA or...+ Experience with MCG or Interqual is preferred. + Utilization review experience is a plus. Job… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Part- time and will work 8-hour, Day ... Schedule:** Part time **Job Shift:** Day **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT REMOTE **Address:** CA Mission Hills 15031 Rinaldi St… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Full- time and will work 8-hour, Day ... time **Job Shift:** Multiple shifts available **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT REMOTE **Address:** CA Mission Hills 15031 Rinaldi… more
- Henry Ford Health System (Warren, MI)
- …Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical experience required. +… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Cottingham & Butler/ SISCO** 1 Positions ID: 4627707008 Posted On 07/01/2025 Refreshed On 10/23/2025 **Job Overview** ** ... Utilization Management Nurse ** **Location** : Onsite in Dubuque, IA. Also accepting remote applicants. We are looking for a nurse just like you - a … more
- CVS Health (Lansing, MI)
- …solutions that promote high-quality healthcare for members. **Position Summary** Join our Utilization Management team as a Nurse Consultant, where you'll apply ... some weekends and holidays, per URAC and client requirements. ** Remote Work Expectations** + This is a 100% ...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
- CVS Health (Columbus, OH)
- …Microsoft Office Applications (Outlook, Teams, Excel) **Preferred Qualifications** - Utilization review experience preferred - Knowledge of Medicare/Medicaid ... operation and work schedule may include weekends, holidays, and evening hours._ **UM Nurse Consultant** Fully Remote - WFH **Schedule** - Mon-Fri 10:30AM-7PM with… more
- CVS Health (Albany, NY)
- …all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state ... 8:30am - 5pm EST. This role is a registered nurse that utilizes MCG rules and applies medical necessity...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of… more
- CenterWell (Austin, TX)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- Centene Corporation (Honolulu, HI)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... organization offering competitive benefits including a fresh perspective on workplace flexibility. Remote Position. Must Reside in Hawaii Registered Nurse (RN)… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- State of Michigan (Lansing, MI)
- …program. To identify psychotropic medication regimens that require additional physician review according to policy, the Utilization Reviewer actively monitors ... Medicaid Utilization Analyst 12 - HSA Psychotropic Medication Oversight...Biweekly Location Lansing, MI Job Type Permanent Full Time Remote Employment Flexible/Hybrid Job Number 3901-26-HSA-MCMCS-001-EST Department Health and… more
- Centene Corporation (Sacramento, CA)
- …perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence… more
