Utilization Management Nurse
Cottingham & Butler
Utilization Management Nurse
We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys making a difference for patients, and prefers working in a professional office setting with daytime office hours and weekends/holidays off.
This position is responsible for working telephonically with providers to evaluate and pre-certify requests such as hospital stays, outpatient surgeries, outpatient tests, care, etc. Review requests and match up to an evidence-based guideline to ensure proper care and ensure the right service is happening at the right time and is medically necessary. In this position you will be handling multiple provider phone calls at any given time and need to be able to handle a very fast paced environment. You will also work closely with participants for referrals to case management and condition management services according to referral criteria and health plan guidelines.
Qualified candidates will have strong multitasking skills, RN and clinical experience, preferably in ER, ICU, mental health, orthopedics, and/or pain management. Bilingual is also preferred.
Full-Time Benefits - Most benefits start day 1
- Medical, Dental, Vision Insurance
- Flex Spending or HSA
- 401(k) with company match
- Profit-Sharing/Defined Contribution (1-year waiting period)
- PTO/Paid Holidays
- Company-paid ST and LT Disability
- Maternity Leave/Parental Leave
- Subsidized Parking
- Company-paid Term Life/Accidental Death Insurance
At Cottingham & Butler, we sell a promise to help our clients through life's toughest moments. To deliver on that promise, we aim to hire, train, and grow the best professionals in the industry. We look for people with an insatiable desire to succeed, are committed to growing, and thrive on challenges. Our culture is guided by the theme of "better every day" constantly pushing ourselves to be better than yesterday – that's who we are and what we believe in.
As an organization, we are tremendously optimistic about the future and have incredibly high expectations for our people and our performance. Our ability to grow as a company, fuels investments in new resources to better serve our clients and provide the amazing career opportunities our employees want and deserve. This is why we are a growth company and why we are committed to being better every day.
$71.1k - $97.8k
...helping individuals access the services and support they need to live safely and independently in their communities? As a Utilization Management (UM) Nurse, you will play a vital role in improving the health and well-being of Illinois Medicaid members by reviewing and...SuggestedFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday$80k - $95k
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...Become a part of our caring community The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to...SuggestedBi-weekly payFull timeTemporary workApprenticeshipWork at officeRemote workHome office- ...Your Role The Utilization Management team independently manages complex utilization and retrospective clinical reviews across multiple... ...Your Knowledge and Experience ~ Associate Degree in Nursing required ~ Bachelor of Science in Nursing or advanced degree...SuggestedFull timeWork at office
- ...Optum, part of UnitedHealth Group, is seeking an Utilization Management Nurse to review patient records and craft defensible appeal letters per guidelines. You will extract data, reference national criteria, and ensure accuracy and compliance. The role requires RN licensure...SuggestedRemote workMonday to Friday
- ...Responsibilities Workers’ compensation utilization management activities include reviewing clinical information to determine medical necessity at all levels of care. You will utilize evidence-based criteria, coordinate care across the continuum, and interact with physicians...Immediate startFlexible hours
- ...outpatient services such as medication management, case management, and counseling. Benefits... ...Health Resource Center is looking for a Utilization Management Reviewer to monitor the... ...must have one of the following: Registered Nurse: Associate Degree in Nursing required. One...Full timeMonday to FridayFlexible hours
- ...Baptist Health in Jacksonville is seeking a PRN Utilization Management Nurse for our Downtown location. You will review patient records to verify hospitalization needs and resource use, and assist with documentation improvement and discharge planning. As a PRN nurse,...Relief
$70.95k - $106.42k
...responded to in ways that fully develop and utilize each person’s talents and strengths. Collaborate closely with physicians, nurses, social workers and a wide range of... ...resources available. Provide utilization management (UM) services which promote quality, cost‑...Contract workWork experience placementWork at office$90k - $107k
...range of professionals, including doctors, nurses, business people, tech experts,... ...opportunities, and much more. The UMCM will utilize clinical knowledge to analyze, assess, and... ...have prior authorization experience in a managed care setting with Medicaid/ACO health plan...Work at officeRemote workFlexible hoursShift work$57.29 - $81.72 per hour
...Job Summary: The Utilization Management Nurse supports the case management department by providing a variety of utilization management functions including but not limited to daily screening of patient admission relative to specified criteria, active involvement in...Full timeWork experience placement- ...associated with El Paso Health's (EPH) inpatient Utilization Review Unit. Ensures the Utilization... ...manner. Ensures the Utilization Management (UM) unit's compliance with all regulatory... ...Three years of experience as a Registered Nurse required, preferably in a clinical...Work experience placementFlexible hours
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote The Utilization Management Registered Nurse is responsible for performing utilization review activities in compliance with federal and state regulations, URAC standards, and Guidehealth policies. This role applies...Bi-weekly payFull timeTemporary workFor contractorsLocal areaRemote workWork from home$60.2k - $107.4k
...as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Utilization Management Nurse will accurately and efficiently review and extract pertinent case details from patient medical records; and craft...Minimum wageFull timeWork experience placementLocal areaRemote workMonday to FridayFlexible hoursWeekend workAfternoon shift- ...Santa Barbara Cottage Hospital is seeking a licensed practical nurse to join BHPS Utilization Management as a remote reviewer of medical necessity and benefit determinations. You will assess cases using clinical guidelines and coordinate with providers and departments...Remote work
- ...Utilization Management Registered Nurse (UM RN) We're seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our growing healthcare team. In this role, you'll perform both inpatient and outpatient utilization reviews while supporting...Remote work
$34 - $55 per hour
...Utilization Management Nurse Full Time - Day shift (Monday-Friday, 8a-5p), hybrid (Work from both office & home. Must be in commutable distance). Position Objective: Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization...Full timeWork at officeWork from homeMonday to FridayDay shift$92.1k - $117.4k
...engages in ongoing efforts to achieve that through equally varied and non-discriminatory means. A Brief Overview Utilization Management Nurse provides comprehensive assessment, coordination, implementation and reporting of complex clinical data. The Utilization...Full timePart timeFor contractorsWork at officeShift work- ...& development Vision insurance Location: Outpatient Case Management West Los Angeles VAMC, 11301 Wilshire Blvd, Los Angeles,... ...Angeles VA Medical Center. Job Summary: We are seeking a Utilization Management Nurse to join our team! As a Utilization Management Nurse, you...Work at officeRelocation packageFlexible hours
- ...Brighton Health Plan Solutions is seeking an Utilization Management Nurse to perform medical necessity and benefit reviews remotely. The role requires current LPN licensure and expertise in CMS/MCG criteria with experience in inpatient/outpatient reviews. The successful...Remote work
- ...ChenMed LLC is seeking a Physician Reviewer to lead Utilization Management (UM) cases across multiple markets. The role includes coordinating with health plans and local teams, attending daily calls, and guiding other physician reviewers in a growing delegated UM program...Local area
- ...ArchWell Health in Nashville is seeking an Utilization Management Nurse to review and evaluate medical services, treatments, and procedures to ensure appropriate, cost-effective care. This role reports to the Director of Utilization Management and partners with providers...
- ...Training & development Vision insurance Outpatient Case Management West Los Angeles VAMC 11301 Wilshire Blvd Los Angeles, CA... ...Opportunities Job Summary We are seeking a Utilization Management Nurse to join our team! As a Utilization Management Nurse on the...For contractorsWork at officeImmediate startRelocation packageMonday to FridayFlexible hours
- ...pay range $45.00/yr - $52.00/yr Delivery Manager - Healthcare, Client Relationship Manager, VMS/MSPHiring Locums & Physicians/Nurses/Allied/Professional Coder Across with Best... .... Poor Computer Skills Summary : The Utilization Management team reviews the inpatient stays...Contract workTemporary workLocumWork at officeHome officeShift work
- ...Spectrum Healthcare Resources is seeking a Utilization Manager Registered Nurse (UMRN) to work entirely remotely from home. The nurse will review cases, educate patients on appropriate care, and manage health care costs for dependents of Active Duty and eligible retirees...Remote workWork from homeMonday to Friday
- ...skills to reach your full potential, HealthOne provides the means to help you achieve your goals. JOB PURPOSE The Utilization Management Nurse performs comprehensive clinical reviews of requested services utilizing clinical criteria, received through various mechanisms...Contract workTemporary workWork at officeImmediate startFlexible hoursNight shift
- ...Elevance Health is seeking a Utilization Management Representative Lead in Columbus, GA. The role supports virtual work with required in-person training and occasional alternate locations within commuting distance. The incumbent will motivate the UM Reps, conduct audits...
$40 per hour
...Utilization Management Nurse We are seeking a dedicated Utilization Management Nurse to provide timely and appropriate prior approval services to members and healthcare providers. The role involves making clinical determinations based on medical policies and criteria...Contract workTemporary workWork at officeRemote work- ...CVS Health is seeking a Utilization Management (UM) Nurse Consultant for a fully remote, full-time role open to CST zone candidates. You will coordinate, document, and communicate all aspects of utilization and benefit management, ensuring appropriate care levels within...Full timeRemote work
- A healthcare staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to reside in PA, DE, or NJ. Key duties involve applying criteria for medical necessity, collaborating...Remote work
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