Utilization Management Nurse RN
$45 - $45.5 per hourMindlance
Overview Job Title: Nurse Case Management Senior Analyst Location: REMOTE Duration: 5-6 Months (Contract possibly Extension) Schedule: Monday - Friday 8am-5pm (EST or CST); no weekends, evenings, or overtime. 8 hours per day, 40 hours per week. Base pay range $45.00/hr - $45.50/hr Job Profile Summary Nurse Case Management Senior Analyst Delivers specific delegated tasks assigned by a supervisor in the Nurse Case Management job family. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Provides clinical assessments, health education, and utilization management to members. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. Manages own caseload and coordinates all assigned cases. Completes day-to-day Nurse Case Management tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members. RN and current unrestricted nursing license required. Required Qualifications MCG or Interqual Experience, 2 years of Utilization Management Experience. EEO “Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.” Employment details Seniority level: Mid-Senior level Employment type: Contract Job function: Analyst and Health Care Provider Industries: Hospitals and Health Care Referrals increase your chances of interviewing at Mindlance. Get notified about new Registered Nurse jobs in United States. #J-18808-Ljbffr Mindlance
- ...CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home role in the EST time zone. The position supports... ...management and benefit coordination, requiring an active RN license and hospital experience. Responsibilities include...SuggestedRemote workWork from home
- ...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...SuggestedRemote work
- ...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 transitions of care and ensuring patients...SuggestedRemote work
- A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...SuggestedRemote workFlexible hoursWeekend workDay shift
- ...University Wexner Medical Center is seeking a Clinical Finance Case Manager - RN to secure complex pre-authorizations and prevent denials. You... ...for assigned payers, with responsibilities spanning Appeals, Utilization Management, and collaboration with Legal and Medical...Suggested
- ...Brighton Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate with partners, and ensure timely, compliant documentation and communications...Work at officeRemote work
- ...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-...
- ...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
- ...DO, active board certification, and a background in Internal or Family Medicine, preferably with experience in health insurance. This position offers a collaborative environment with opportunities to leverage clinical expertise in utilization management. #J-18808-LjbffrRemote 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
- ...CVS Health is seeking an experienced Utilization Management (UM) Nurse Consultant for a 100% remote, full‑time role serving candidates in the EST or CST zones. You will coordinate, document, and communicate utilization and benefit management activities to ensure appropriate...Full timeRemote work
$26.01 - $56.14 per hour
...Health, is a URAC-accredited medical management organization founded in 1993. We provide... ...complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review... ...~ Active, unrestricted RN license in your state of residence with...Hourly payFull timeTemporary workLocal areaRemote workMonday to FridayFlexible hoursShift work- ...Currently seeking a Utilization Management RN . Please see details and qualifications below: Position is remote - candidate must reside in... ...provide own equipment Must have an active PA license or a Nurse Licensure Compact to include PA. ** Minimum of three (3)...Immediate startRemote workDay shift
- ...Humana is seeking a Compliance Nurse 2 to review utilization management activities and documentation, ensuring adherence to policies, procedures, and regulations. The role involves analyzing data to assess outcomes and operational metrics and making independent judgments...Shift work
- Mass General Brigham Health Plan Holding Company, Inc. is seeking an RN-based Utilization Management Nurse to support network adequacy reviews and authorization decisions for ACO, HMO, and EPO products. The role emphasizes medical necessity assessment and robust payer knowledge...Remote job
$35 - $37 per hour
...job poster from The Judge Group. Job Title: Remote Registered Nurse (RN) - Temp to Perm Pay Rate: $36-37/hr Start Date: April 7th Licenses... ...their travel assignments. No NPs, whether practicing or not. Utilization Review experience is helpful but not required; critical...Remote jobPermanent employmentFull timeTemporary workMonday to Friday- Santa Barbara Cottage Hospital is seeking a registered nurse to perform utilization review of inpatient, outpatient, and post-acute services. The... ..., and coordinating with the Medical Director and care management teams to ensure appropriate care across the health care continuum...
$75 per hour
Utility Management Nurses | $75/hr Remote This range is provided by Crossing Hurdles. Your actual pay will be based on your skills and experience... ...coding, and privacy standards. Requirements Registered Nurse (RN) or equivalent clinical background. Strong experience (3-5+...Remote jobHourly payContract workPart timeFlexible hours- IntusCare is seeking a Utilization Management Nurse to ensure high-quality, cost-effective, and compliant care for PACE participants. You will review service utilization, guide care decisions, and support transitions across care settings, collaborating with Interdisciplinary...Remote job
$42 per hour
...risk adjustment, population health, and utilization management. IntusCare empowers teams to take... ...Overview The Contract Utilization Management Nurse plays a critical role in ensuring high-... ...management experience. Current RN license Proven experience working in risk...Contract workRemote work- Texas Health Resources is seeking an Utilization Management RN - Clinical Review to support remote admissions reviews across THR facilities. You will assess initial admission status for inpatient, observation, and outpatient settings, using medical necessity criteria and...Remote job
$42 per hour
IntusCare is seeking a Contract Utilization Management Nurse to ensure high-quality, cost-effective, and compliant care for PACE participants. The role collaborates with interdisciplinary teams to review utilization, guide care decisions, and support transitions across...Remote jobHourly payContract work- Appworkshub is seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role, you will conduct inpatient and outpatient utilization reviews, support transitions of care, and ensure compliance with...Remote job
- MaziCTools is seeking a Freelance Utilization Management Nurse Consultant to work remotely in the United States. This full-time role requires an active RN licensure and 3+ years of clinical experience. Responsibilities include assessing healthcare services, communicating...Remote jobFull timeFreelanceWork at officeMonday to FridayWeekend work
- A community hospital in Arizona is seeking a Utilization Management Nurse to ensure healthcare efficiency and quality through diligent review of medical records and adept communication. You'll engage with multiple stakeholders to uphold clinical decision-making and regulatory...
$38 - $43 per hour
Join Personify Health as an RN Utilization Management Team Lead, where you will provide clinical and operational leadership in a dynamic environment. With a strong emphasis on compliance and quality, you will support timely coverage determinations and enhance team performance...Hourly pay- IntusCare is seeking a Utilization Management (UM) Manager to lead the UM nurse team supporting a PACE program. You will own end-to-end UM delivery, ensure SLA compliance, and apply clinical decision support criteria across cases to optimize care and efficiency. The role...Remote job
- A healthcare solutions company is seeking a Utilization Management Nurse Reviewer to assess the appropriateness of medical services and collaborate with healthcare professionals. This role requires a Licensed Practical/Vocational Nurse with clinical experience and skills...
$118.13k - $155.79k
...Presbyterian Hospital is seeking a Case Manager - RN for Inpatient Units. This full-time position involves discharge planning and utilization management for patients in Brooklyn Methodist... ...Candidates should have a Bachelor's in Nursing and RN licensure; preferred...Full time- University of Miami Health System seeks a full-time Utilization Review Case Manager to work remotely. The role reviews patient charts for prior authorization, concurrent and retrospective utilization, coordinating with the care team for timely and appropriate care. You...Remote jobFull time
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