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 1 day ago
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New York, NY1 day 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...SuggestedWork at officeRemote work
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New York, NY1 day ago - ...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-...Suggested
PacificSource
New York, NY4 days ago - ...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
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New York, NY2 days ago - ...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 utilization management and benefit coordination, requiring an active RN license and hospital experience. Responsibilities...Remote workWork from home
CVS Health
New York, NY3 days ago - ...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
Santa Barbara Cottage Hospital
New York, NY2 days ago $32.01 - $68.55 per hour
...Registered Nurse (RN) – Utilization ManagementJoin a dynamic healthcare team and make an impact on patient care from wherever you work.We are... ...experienced Registered Nurse (RN) to support our 24/7 Utilization Management operations. In this role, you will use your clinical...Hourly payFull timeTemporary workWork at officeWork from homeAfternoon shiftOak St. Health
New York, NY6 hours ago$42 per hour
...care coordination, risk adjustment, population health, and utilization management. IntusCare empowers teams to take control of their operations... ...system. Role Overview The Contract Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective...Contract workRemote 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 receive...Remote work
$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$26.01 - $56.14 per hour
...division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-... ...lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a...Remote jobHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hoursShift 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...Remote workFlexible hoursWeekend workDay shift
The Judge Group, LLC
New York, NY4 days ago - ...Mass General Brigham is seeking a Per Diem nurse to coordinate complex patient care and serve as the primary contact for access, diagnostics, treatment activities, and education. The role involves collaboration with an interdisciplinary team and discharge planning....Daily paidRemote work
Santa Barbara Cottage Hospital
New York, NY3 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, NY1 day ago - Humana is seeking an experienced Utilization Management Nurse 2 to support medical necessity reviews, care coordination, and discharge planning for Kentucky Medicaid members. You will use clinical judgment to decide on level of care and communicate decisions with providers...Remote jobWork at officeWork from homeShift work
- ...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
Santa Barbara Cottage Hospital
New York, NY4 days ago $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- Jefferson Health Plans in Philadelphia, PA, is hiring a Registered Nurse for Utilization Management. You will apply medical necessity criteria to determine patient status and coordinate denial/appeal activities for inpatient hospital care. Work is varied hours with an...Afternoon shift
- Currently seeking a Utilization Management RN . Please see details and qualifications below: Position is remote - candidate must reside in PA,... ...Must provide own equipment Must have an active PA license or a Nurse Licensure Compact to include PA. **Minimum of three (3)...Immediate startRemote workWeekend workDay shift
- 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
$34 - $35 per hour
Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical Nurse - Work from Home! Get AI-powered advice on this job and more exclusive features. Direct message the job poster from BroadPath Global Talent Attraction and Branding Specialist...Full timeWork at officeRemote workWork from homeNight shift- ...Sciences University is seeking a full-time TH Utilization Review Quality Assurance Senior Coordinator / RN Case Manager in New York. The role focuses on hospital case... ...care. The position requires NY RN licensure, a nursing degree, and PRI certification, with preferred graduate...Full time
- ...not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange... ..., following established MetroPlusHealth Utilization Management policies, procedures, and... ...to practice as a Registered Professional Nurse (RN), Licensed Practical Nurse (LPN), or...Shift work
$40 per hour
...an expert clinician who helps them navigate day-to-day health management. Why Join Cecelia Health? Tackle the obesity epidemic: Help... ...anti-obesity medications is preferred. Proven experience utilizing motivational interviewing to promote behavior change. Demonstrated...Hourly payFull timePart timeFor contractorsLive inLocal areaRemote workHome officeFlexible hours- ...plan and provide, ongoing coordination and management of service delivery through an... ...timelines and quality standards related to Utilization Management. Maintain and submit reports... ...degree Valid New York State Registered Nurse (RN) required. Minimum three (3) years Medical...Work at office
$60.2k - $107.4k
UnitedHealth Group is seeking a Registered Nurse with at least 3 years of bedside nursing experience to support appeals, data extraction, and HIPAA-compliant communications. This full-time position is remote within the United States and offers a pay range of $60,200 to...Remote jobFull timeWork at office- ...seeking healthcare enthusiasts to join us. Job Summary The Nurse, Care Management is a compassionate and skilled clinician responsible for... ...with at least 1-2 years in care management, case management, utilization management, or care coordination. LPN required, RN...Work at officeFlexible hoursWeekend work
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...occurring substance use disorders, high utilization of emergency/crisis services, and criminal... ...ATI mandates. Job Title Registered Nurse Job Summary The Bronx Nathaniel Assertive... ...The Registered Nurse provides medication management and administration, health assessment, counseling...Full timeSummer workWork at officeMonday to FridayFlexible hoursShift work
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