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
- ...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...SuggestedLocal area
- ...A leading independent review organization is seeking a Utilization Management Physician Reviewer for a full-time remote role. Candidates must possess an active Nebraska medical license and have a minimum of 5 years clinical practice experience. Responsibilities include...SuggestedFull timeCasual workRemote workMonday to Friday
- ...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...SuggestedRemote work
$29 - $52 per hour
...global scale. Join us to start Caring. Connecting. Growing together. The Utilization Review Nurse, RN is responsible for providing clinically efficient and effective Inpatient utilization management. Reviews inpatient criteria for acute hospital admissions and concurrent...SuggestedHourly payMinimum wageFull timeWork experience placementLocal areaRemote workMonday to FridayShift work- ...CVS Health is seeking a Registered Nurse for Utilization Management on a work-from-home schedule with weekend coverage. You will assess, plan, implement, coordinate, monitor, and evaluate options to facilitate healthcare services and member benefits. Responsibilities...SuggestedWork from home
- ...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
$29.1 - $62.32 per hour
...schedules will be determined in collaboration with management to ensure adequate weekend coverage. Position Summary Utilize your clinical experience and skills in a... ...as directed. Required Qualifications Registered Nurse Education: Diploma RN acceptable; Associate degree...Hourly payFull timeTemporary workWork at officeLocal areaWork from homeShift workWeekend work- Optum is seeking an Utilization Management Nurse to review medical records, extract key case details, and craft defensible appeal letters in line with process instructions and guidelines. The role requires an RN with an associate degree, 3+ years bedside nursing, HIPAA...Remote job
- ...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...
- ...Exceptional in Georgia We are seeking an experienced Infusion RN Manager/Interim Administrator to help lead our Georgia operations,... .... This is a unique dual leadership opportunity for a Registered Nurse who understands home infusion, enjoys building programs and teams...Interim role
- ...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
$140 - $145 per hour
...Oscar is hiring a Physician Reviewer to join our Utilization Management Team. You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This remote role is open...Hourly payRemote workWeekend 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
$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- The Utilization Management (UM) Nurse is responsible for conducting clinical reviews and assessing the medical necessity, appropriateness, and efficiency of healthcare services requested by providers and members. This role supports the health plan’s utilization management...
- Optum is seeking an Inpatient Care Management Nurse to assess and interpret member needs, guiding utilization of health services to improve outcomes. You will collaborate with clinicians, perform case reviews, and support discharge planning from home-friendly settings....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- ...Reports To Nursing Supervisor/ VP of Medical Services Department I/DD Reports To Nursing... ...York City. Overview The RN provides care management to Individuals with Developmental... ...OPWDD experience and knowledge Ability to utilize nursing assessment skills in an autonomous...Full timeApprenticeshipWork experience placementRemote workFlexible hours
$118.61k - $130k
...have an exciting opportunity to join our team as a Assistant Nurse Manager OR Orthopedics Evenings - LOH. In this role, the successful candidate... ...Staff and Nursing Education in identifying, addressing, and utilizing available resources to meet the learning needs of...Immediate startShift workAfternoon shift$103.97k
...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$97.91k
...CIVIL SERVICE TITLE OF THE PUBLIC HEALTH NURSE** The Division of Family and Child... ...nursing and paraprofessional staff - Utilizing Automated Student Health Record (ASHR) to... ...staff - Analyzing data collected in OSH management reports, i.e. walk ins, case management...Permanent employmentFull timeWork at officeWork from home2 days per week- ...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
$70k - $115k
...Registered Nurse Manhattan, Queens, Bronx, Brooklyn - Various, NY 10001 Overview... ...potential health problems; providing case management services; and actively collaborating... ...flexibility and the ability to learn and utilize team building strategies The ability...Full timeWork at officeLocal areaShift work$40 per hour
...an expert clinician who helps them navigate day-to-day health management. Why Join Cecelia Health? ~ Tackle the obesity epidemic... ...anti-obesity medications is preferred. Proven experience utilizing motivational interviewing to promote behavior change....Hourly payFull timePart timeFor contractorsLive inLocal areaRemote workHome officeFlexible hours$80 per hour
...policies, state and federal regulations.. Manages requests for services from providers,... ...guidelines, policies, procedures, and protocols.• Utilize clinical skills to assess and document... ...to practice as a Registered Professional Nurse in New York State requiredCertified Case...Daily paidWork experience placementFlexible hours- ...Job Description Job Description Ambulatory Surgery Center is currently seeking an Part time OR RN Nurse to join our team. We are a pain management practice with a one room OR where we do epidurals, nerve blocks, medial branch block etc...the RN will be responsible...Part time
- ...of the supervising Assistant Director of Nursing in Community Care, assesses, plans,... ...non-physician provider as needed. 5. Utilizes input from patient, caregiver, MD and peers... ...services. 10. Collaborates with case managers and other disciplines regarding the patient...Part time
- ...QSL Management is seeking a Staff Nurse for The Blake at Glenncrest at Webb Gin in Georgia. The role requires current LPN licensure, CPR certification, and flexibility to cover weekends and holidays while delivering high-quality care in a senior living setting. The Nurse...
- ...and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding... ...disciplines including Care Manager, Assessment Nurse and Primary Care Physician or other... ...program, Bachelor's preferred Knowledge with Utilization management processes preferred Current...
$133.6k - $153.22k
...of America) Description Find Out How We Stay Amazing Registered Nurse - Home Care At Lawrence Homecare of Westchester, nursing is a... ...patient volume while ensuring timely OASIS completion, safe caseload management, and high-quality patient care. Furthermore, it's your...Full timeMonday to FridayShift work
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