Utilization Management Nurse
The Judge Group, LLC
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 with providers, and managing discharge planning. Candidates must have an active PA RN license and a minimum of three years in Medical/Surgical experience, along with proficiency in Microsoft's applications and InterQual criteria. #J-18808-Ljbffr
Vacancy posted 19 hours ago
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- ...ProMedica is seeking a Utilization Management RN for a remote, part-time role in Ohio with a 20-hour work week. You will review admissions and... ...and care quality. Qualifications include a NLN-accredited nursing program, at least 3 years acute care nursing, and an active...SuggestedPart timeRemote workWork from home
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New York, NY19 hours ago - ...Clover Health is hiring a Registered Nurse (RN) for Home Health Utilization Management. This remote role supports CMS-guided reviews, medical necessity determinations, and collaboration with providers to ensure appropriate, efficient care within Home Health services. The...SuggestedRemote work
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New York, NY19 hours ago - ...Humana Inc. is seeking a Health Services Lead to oversee the design, implementation, and sustainability of Utilization Management clinical programs. You will ensure clinical integrity, regulatory alignment, and governance across markets while standardizing national UM...SuggestedRemote work
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New York, NY19 hours ago - ...Santa Barbara Cottage Hospital is seeking a Per Diem RN for Utilization Management Review. This role offers the flexibility of remote work and requires a valid MA Registered Nurse State License. The successful candidate will participate in ensuring quality patient care...SuggestedDaily paidRemote work
Santa Barbara Cottage Hospital
New York, NY19 hours ago - ...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
Santa Barbara Cottage Hospital
New York, NY2 days ago - ...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-Ljbffr...Remote work
IntePros
New York, NY19 hours ago - ...University Wexner Medical Center is seeking a Clinical Finance Case Manager - RN to secure complex pre-authorizations and prevent denials.... ...for assigned payers, with responsibilities spanning Appeals, Utilization Management, and collaboration with Legal and Medical...
Ohio State University
New York, NY19 hours ago - ...Santa Barbara Cottage Hospital is seeking a Registered Nurse to lead utilization review, assess coordination of care opportunities for members... ...and participate as an active team member of the Utilization Management Team. You will evaluate medical necessity, document...
Santa Barbara Cottage Hospital
New York, NY19 hours ago - ...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
Brighton Health Plan Solutions
New York, NY19 hours ago - 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 receive...Remote work
- ...CVS Health is seeking a Utilization Management (UM) Nurse Consultant for a fully remote, 100% work-from-home role available to candidates in the EST Zone. You will review medical necessity, coordinate care, and document UM processes to ensure safe, cost-effective care...Remote workWork from home
4062 Aetna Resources, LLC
New York, NY1 hour ago $26.01 - $74.78 per hour
...And we do it all with heart, each and every day. Position Summary CVS Health Aetna has an opportunity for a full‑time Utilization Management (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and...Hourly payFull timeTemporary workWork at officeLocal areaFlexible hours- 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...Remote workFlexible hoursWeekend workDay shift
The Judge Group, LLC
New York, NY4 days ago - ...Obsidian is seeking experienced Utilisation Management and Case Management leaders to shape AI tools that enhance clinical review and improve care coordination. The role involves leading operations, managing physician advisor programs, and ensuring compliance with healthcare...
Obsidian
New York, NY19 hours ago $45k - $70k
...A healthcare services company is seeking a Utilization Management Nurse Reviewer to ensure medical services are used appropriately. The role involves reviewing medical records and coordinating care while adhering to guidelines. Candidates should possess an unrestricted...Remote workDane Street
New York, NY1 day ago- ...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
The Judge Group, LLC
New York, NY4 days ago $45k - $70k
A healthcare management firm is seeking a Utilization Management Nurse Reviewer to ensure efficient use of medical services. The role involves reviewing medical records, assessing treatment necessity, and collaborating with healthcare providers. Candidates should possess...Remote job- ...Job Description Lead Nurse Restore Hyper Wellness Do you have a passion for nursing but... ...Roles of a Restore Lead Nurse People Management Manage a team of Restore Nurses by performing... ...Hyperbaric Oxygen Therapy sessions. Utilize blood test offerings to help clients optimize...Hourly payPart timeWork at office
6AM City
New York, NY19 hours ago - ...health to endocrinology and psychiatry. We also provide nursing home support, care management services, and in-home medical services through our... ...initiatives by improving care transitions, reducing avoidable utilization, closing care gaps, and enhancing patient outcomes...Work at officeRemote workWeekday work
Essen Medical Associates
New York, NY1 day ago - Brighton Health Plan Solutions is seeking an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. The role involves collaborating with healthcare partners, documenting determinations, and guiding case management teams...Remote jobWork at office
- ...Coordinate Behavioral Health patient care • Manage Behavioral Health caseloads Experience with Care Coordination, Utilization review and discharge planning Computer... ...minimum of clinical experience as a Registered Nurse. -Experience with Care Coordination, Utilization...
$54 - $64 per hour
...compassionate and dedicated Registered Nurses (RN) to join our team in our Egg Harbor... ...changes to Clinical or Client Services Manager Follow up with, execute, and properly document... ...care management and services provided, utilizing a state-of-the-art touch pad tablet...Weekly payFull timePart timeWork at officeLocal area$100 per hour
...Join to apply for the Per Diem Nurse Anesthetist-QHC/ELM-12270-031 role at Mount Sinai... ...this employee administers, monitors and manages patient’s care before and after anesthesia... ...working condition of all equipment to be utilized in the administration of the anesthesia care...Hourly payDaily paidFull timeTraineeshipWork experience placementLocal areaImmediate startNight shiftMount Sinai Health System
New York, NY12 hours ago$125.36k - $188.05k
...Care Management Position - Administrative Role Job Type Permanent Specialty Registered Nurse State NY Location NY - New York Description *Care Management Manager role available for an experienced...Permanent employmentMedSource
New York, NY1 day ago- ...All Jobs Federal Credentialing & Privileging Support Nurse (DHA CQM Program) Fully Remote • United States Full-time Description Overview Tanaq Management Services (TMS) delivers professional, scientific, and technical services and information technology (IT) solutions...Full timeContract workFor contractorsLocal areaRemote workMonday to Friday
St. George Tanaq Corporation
New York, NY1 day ago - ...of our community ... we are proud to announce that we are a tobacco‑free campus. Job Summary and Responsibilities As our Utilization Management Nurse, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision‑making,...
Santa Barbara Cottage Hospital
New York, NY1 day ago - ...professionals, every day. Works Under The Supervision Of The Nurse Manager/Clinical Coordinator. The Registered Nurse (Rn) Assesses,... ...Performance Expectations For Customer Service, Teamwork, Resource Utilization, And Staff And Self Development As Outlined In Performance...
Yale New Haven Hospital
New York, NY1 hour ago $18k
...within the communities we serve. Our doctors, nurses, and allied health professionals are a regular... ...the general direction of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient...Full timePart timeLive outSanta Barbara Cottage Hospital
New York, NY1 day ago$30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Hourly payPart timeRemote workSanta Barbara Cottage Hospital
New York, NY1 day ago$34 - $40 per hour
...LPN's & RN's About the Role Medix is seeking an experienced Utilization Review Nurse to support our mission of improving patient care through... ...surgical, or critical care). 1+ year in utilization review/management with home health reviews. Proficiency with EMR/utilization...Full timeRemote workMedix
New York, NY12 hours ago
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