Utilization Management Nurse
Georgia Job Openings
Description Help Us Build Something Exceptional in Georgia We are seeking an experienced Infusion RN Manager/Interim Administrator to help lead our Georgia operations, support home care licensure, and build the clinical foundation for a high-quality home infusion program. This is a unique dual leadership opportunity for a Registered Nurse who understands home infusion, enjoys building programs and teams, and wants to influence how care is delivered from the very beginning. As our Infusion RN Manager and Interim Administrator, you will help lead our efforts to obtain and maintain our Georgia home care license while developing the clinical infrastructure, relationships, processes, and team needed to build a strong home infusion program. Why this Role is Different: Help shape the future of Georgia Operations Play an integral role in achieving Georgia home care licensure Build and develop a high-quality home infusion nursing program Develop relationships with healthcare providers and organizations throughout the community Recruit, mentor, and support a growing clinical team Influence operational strategy and clinical excellence Create processes that improve both employee and client experiences Help establish a culture of quality, accountability, collaboration, and compassionate care Work alongside leaders who value innovation, teamwork, and continuous improvement What You'll Do: Serve in the dual capacity of Infusion RN Manager and Interim Administrator for our Georgia operations. Lead day-to-day clinical and operational activities. Partner with executive leadership on strategic planning, program development, and growth initiatives. Foster a culture centered on quality, accountability, collaboration, and compassionate care. Identify opportunities to improve workflows, operational efficiencies, employee experience, and client satisfaction. Collaborate closely with HR, Recruiting, Finance, Compliance, Operations, and other organizational leaders. Help ensure operations meet applicable Georgia regulatory requirements and organizational standards. Monitor quality assurance, clinical outcomes, and performance improvement initiatives. Promote consistent documentation, clinical oversight, and adherence to established standards of care. Build strong relationships with referral sources, healthcare providers, hospitals, case managers, and community organizations. Represent the organization professionally within the Georgia healthcare community. Help identify opportunities to expand services and strengthen referral partnerships. Support the development of a scalable home infusion program focused on clinical quality and an exceptional patient experience. Equal Opportunity Employer Venture Forthe Home Care is proud to be an Equal Opportunity Employer committed to fostering a diverse and inclusive workplace. Work Authorization Candidates must be authorized to work in the United States without current or future employer sponsorship. Requirements What We're Looking For: Holds a current, active Georgia RN license in good standing Home infusion experience - required Has supervisory, management, or clinical leadership experience within a healthcare setting Is comfortable helping establish and improve clinical programs, policies, and processes Possesses strong leadership, organizational, critical-thinking, and communication skills Understands the importance of balancing regulatory compliance, clinical excellence, employee experience, and operational performance Is passionate about helping individuals receive high-quality care safely in their homes Wants to grow alongside an expanding organization Home care experience is strongly preferred Infusion Therapy Experience May Include: Immunoglobulin therapy: IVIG and SCIG Specialty infusions and biologics, including Ocrevus, Tysabri, Briumvi, Prolastin-C, Vyepti, Ultomiris, Skyrizi, Inflectra, Simponi, Remicade, Fabrazyme, and other specialty therapies Medication classes including monoclonal antibodies, immunosuppressives, enzyme/protein replacement therapies, and immunomodulators Supportive therapies including hydration therapy, methylprednisolone, magnesium, potassium, and other prescribed therapies Acute therapies including TPN and IV antibiotics Home Infusion Pumps such as: Curlin, CADD-Solis, Sapphire, Freedom60. Infusion Device Types may include: Peripheral IV, Implanted port/Mediport, PICC, Subcutaneous injection/infusion Other Desired Clinical Skills: Peripheral and central-line blood draws Central-line dressing changes Patient assessment and monitoring Patient and caregiver education Self-administration education and training #J-18808-Ljbffr
- 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
- ...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
- ...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...SuggestedWork at officeRemote work
- ...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
- ...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...Full timeCasual workRemote workMonday to Friday
$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...Hourly payMinimum wageFull timeWork experience placementLocal areaRemote workMonday to FridayShift 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$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$45 - $45.5 per hour
Overview Job Title: Nurse Case Management Senior Analyst Location: REMOTE Duration: 5-6 Months (Contract possibly Extension) Schedule: Monday... ...services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, coordinate,...Contract workImmediate startRemote workMonday to FridayAfternoon shift- Humana is seeking a Utilization Management Nurse 2 to apply clinical nursing skills in coordinating, documenting and communicating medical services and benefit determinations. This remote role may require occasional travel to Humana's offices for training or meetings....Remote job
- 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 NICU Utilization Management Nurse Consultant to support high-risk neonatal populations. The role involves clinical review, care coordination, and evidence-based decision-making across remote settings. You will collaborate with neonatologists, hospitals...Remote job
$26.01 - $68.55 per hour
...Fully remote with requirement to work the following schedule: Monday-Friday 8:00am-4:30pm EST. Position Summary As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit...Hourly payFull timeTemporary workWork at officeLocal areaRemote workMonday to FridayWeekend 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... ...directed. Required Qualifications Registered Nurse Education: Diploma RN acceptable; Associate degree...Hourly payFull timeTemporary workWork at officeLocal areaWork from homeShift workWeekend 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...
- ...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$29 - $52 per hour
Optum is seeking a Utilization Review Nurse, RN, to lead inpatient utilization management, applying evidence-based guidelines and criteria to determine medical necessity for admissions and authorizations. The role requires 3+ years of clinical nursing and 1+ year in Utilization...Remote jobHourly pay- Youritrecruiter UM Nurse role involves conducting clinical reviews to assess medical necessity and efficiency of services requested... ...by providers and members. It supports the health plan’s utilization management aligned with clinical guidelines and accreditation standards...
$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 — talk with your recruiter to learn more. Base pay range $45.00/hr - $75.00/hr Position: Utility Management Nurse (Insurance...Remote jobHourly payContract workPart timeFlexible hours- 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...
$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- NeueHealth is seeking a Utilization Management Prior Authorization Nurse to ensure appropriate benefit coverage and evidence-based care for assigned populations. You will collaborate with Medical Directors and clinicians to review authorizations for treatments, medications...
- 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
- CVS Health is seeking a Utilization Management Nurse Consultant to coordinate, document and communicate all aspects of the utilization/benefit management program. You will ensure the member receives appropriate care at the right time and place, while adhering to federal...Remote jobFull timeMonday to Friday
- 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
- Currently seeking a Utilization Management RN . Please see details and qualifications below: Position is remote - candidate must reside in the... ...provide own equipment Must have an active PA license or a Nurse Licensure Compact to include PA. ** Minimum of three (3) years...Immediate startRemote workDay shift
- Phoebe Putney Memorial Hospital in Albany, GA, is seeking an RN UR Specialist to manage utilization review activities, secure authorizations, and support medical necessity justification for hospital services. You will liaise with insurance payers and care management staff...Full time
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