Utilization Management Nurse
Santa Barbara Cottage Hospital
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. Requirements include a Bachelor's or Master's in Nursing and an MA Registered Nurse License, with 2–3 years of acute care or discharge planning experience preferred. Per diem schedule, remote work option, located in Boston area. #J-18808-Ljbffr
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Utilization Management Nurse in New York, NY vacancy
- 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...SuggestedRemote work
The Judge Group, LLC
New York, NY4 days 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, NY4 days ago $26.01 - $68.55 per hour
...CVS Health Utilization Management PositionWe're building a world of health around every individual — shaping a more connected, convenient and... ...writtenRequired Qualifications- 2+ years of experience as a Registered Nurse in adult acute care/critical care setting- Must have active...SuggestedHourly payFull timeTemporary workWork at officeAfternoon shiftOak St. Health
New York, NY5 days ago- ...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-LjbffrSuggestedRemote work
IntePros
New York, NY4 days 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...Suggested
Ohio State University
New York, NY4 days 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-...
PacificSource
New York, NY2 days 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, 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
ChenMed
New York, NY5 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, NY5 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, NY1 day ago - ...CVS Health is seeking an experienced Utilization Management (UM) Nurse Consultant for a 100% remote position in the EST zone. The role focuses on coordinating, documenting, and communicating utilization and benefit management, ensuring appropriate level of care while meeting...Remote work
Hispanic Alliance for Career Enhancement
New York, NY5 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, NY3 days ago$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- Job Responsibilities Job Details Performs utilization management functions, applying medical necessity criteria to determine the appropriate... ...home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce...Daily paidFull timeTemporary workPart timeFlexible hoursShift workAfternoon shift
- 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
- 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
...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$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- 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
- ...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, NY4 days ago - 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, NY2 days ago - ...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, NY2 days ago - Jefferson Health Northeast is seeking a healthcare professional to perform utilization management and denial/appeal activities for inpatient care from a hospital setting. You will collaborate with the Case Management team and Physician Advisor to ensure appropriate patient...Afternoon 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- 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
- Netsmart is seeking a Registered Nurse with solid utilization management experience to perform ED utilization reviews and admissions screening using established criteria. The role requires adept EMR review, strong clinical judgment, and collaboration with ED physicians...Remote job
- 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
- 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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