Utilization Management Nurse
Anacalifornia
Optum, part of UnitedHealth Group, is seeking an Utilization Management Nurse to review patient records and craft defensible appeal letters per guidelines. You will extract data, reference national criteria, and ensure accuracy and compliance. The role requires RN licensure, a relevant associate degree, and 3+ years bedside nursing (ED/Telemetry/ICU/CCU). Telecommuting is allowed within the U.S. and the schedule is Monday–Friday, 40 hours. #J-18808-Ljbffr
- ...Humana Inc. is seeking an Utilization Management Nurse 2 to apply clinical nursing skills in coordinating, documenting and communicating medical services and benefit determinations. The role involves interpretation of criteria and independent decision-making to provide...SuggestedRemote work
$71.1k - $97.8k
...helping individuals access the services and support they need to live safely and independently in their communities? As a Utilization Management (UM) Nurse, you will play a vital role in improving the health and well-being of Illinois Medicaid members by reviewing and...SuggestedFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday- ...across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider... ...faster healthcare is possible. About This Opportunity: As a Utilization Management Nurse, you’ll oversee and manage the Utilization Management...SuggestedFull timeImmediate startRemote workMonday to FridayFlexible hours
$60.2k - $107.4k
...as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Utilization Management Nurse will accurately and efficiently review and extract pertinent case details from patient medical records; and craft...SuggestedMinimum wageFull timeWork experience placementLocal areaRemote workMonday to FridayFlexible hoursWeekend workAfternoon shift- UnitedHealth Group's Optum is seeking a Utilization Management Nurse to review patient records and craft defensible appeal letters in accordance with OPAS guidelines. This role supports 40 hours per week, Monday-Friday, with telecommuting flexibility across the U.S. and...SuggestedRemote jobMonday to Friday
- UnitedHealth Group is seeking a qualified Utilization Management Nurse to review patient records and craft appeal letters, ensuring accuracy and compliance. You will support OPAS and enterprise goals while collaborating across teams to deliver high-quality reviews. Requirements...Remote jobWork at officeFlexible hours
$90k - $107k
...range of professionals, including doctors, nurses, business people, tech experts,... ...services from out-of-network providers. Utilizing clinical knowledge, the UM Nurse will review... ..., concurrent, retrospective utilization management reviews utilizing Interqual ®, company policies...Work at officeRemote workFlexible hoursShift work- Optum is seeking an Utilization Management Nurse to review patient records and craft defensible appeal letters according to process instructions. You will extract pertinent details, reference clinical guidelines, and ensure compliance with HIPAA and policies. Position...Remote job
- Description PRIMARY PURPOSE: To support utilization management, quality improvement, population health, and performance improvement activities... ...rooms. MINIMUM QUALIFICATIONS: Associate Degree in Nursing required ; Bachelor of Science in Nursing (BSN) preferred....Work at office
- ...assignment. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Utilization Management Supervisor, this position: Ensures that prior authorization... ...SUCCESSFUL Desirable Qualifications Bachelor’s degree in Nursing Working knowledge of managed care, the Medicare D-SNP and Medi...Full timeTemporary workPart timeLive inWork at officeLocal areaRemote work
- Valenz Health is seeking a Utilization Management Nurse to oversee and manage the UM process, ensuring the delivery of high-quality, cost-effective care for plan participants. You will review prospective, concurrent, and retrospective UM activities and collaborate with...Remote job
$44.63 - $53.55 per hour
## Utilization Management Nurse, RNApplylocations: Remotetime type: Full timeposted on: Posted 3 Days Agojob requisition id: JR100099About Altais:At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We...Local areaFlexible hours$26.01 - $56.14 per hour
...person, one family and one community at a time. Position Summary Utilization Management is a 24/7 operation and work schedules will include weekends... ...Qualifications 2+ years of experience as a Registered Nurse in adult acute care/critical care setting Must have active current...Hourly payFull timeTemporary workWork experience placementWork at officeLocal areaWork from homeAfternoon shift- CVS Health Corporation is seeking an experienced Registered Nurse for Utilization Management. The role examines and coordinates care options, applying clinical criteria to determine coverage and guide patient pathways. The position operates in a 24/7 environment with weekends...Remote jobLive inHome officeWeekend workAfternoon shift
- Humana Inc. is seeking a Utilization Management Nurse to review and authorize LTSS and HCBS for Illinois Medicaid members. You will evaluate clinical information, make evidence-based coverage determinations, and coordinate with providers and interdisciplinary teams to...Remote job
- The Alliance in Central California invites experienced RNs to join our temporary Utilization Management team. You will review prior authorization requests and perform concurrent or retrospective reviews of acute inpatient care using established criteria to ensure contractual...Temporary work
$2,940 per week
...Registered Nurse (RN) | Utilization Review Location: East Elmhurst, NY Agency: talent4health Pay: $2,940 per week Shift Information: Days - 5 days x 8 hours Contract Duration: 8 Weeks Start Date: 9/14/2026 About the Position Evaluates...Full timeContract workShift work$2,940 per week
...Registered Nurse (RN) | Utilization Review Location: East Elmhurst, NY Agency: talent4health Pay: $2,940 per week Shift Information: Days - 5 days x 8 hours Contract Duration: 8 Weeks Start Date: 9/14/2026 About the Position TravelNurseSource...Full timeContract workTemporary workShift work- Centene Management Company LLC is seeking a Clinical UM leader to oversee Prior Authorization, Concurrent Review, and Retrospective Review... ...a few times per year. The position emphasizes guiding utilization management operations, developing policies, and collaborating...Remote job
$77.08k - $119.47k
## Utilization Review NurseApplylocations: 43 New Scotland Avenue Albany, NY 12208time type:... ...requisition id: 71163Department/Unit:Care Management/Social WorkWork Shift:Day (United States... ...*Minimum Qualifications:** • Registered nurse with a New York State current license. •...Shift work$110k
...State: Nyack, New York Department: Care Management Work Shift: Day Work Days: MON-FRI... ...time frame and with the most efficient utilization of resources. Carries out activities related... ...by the patient. Plans transfers to nursing facilities, rehab and other acute care...Daily paidFull timePart timeFlexible hoursShift work- ...Description Join our team as a day shift/variable, full time, RN Case Manager - Utilization Review, at INTEGRIS Baptist Medical Center, Oklahoma City,... ...Heart Association within 30 days of hire RN (Registered Nurse) Current licensure as a Registered Nurse (RN) in the State...Full timeWork at officeDay shift
- P3 Health Partners is seeking a Utilization Management Manager to oversee the daily operations of the UM department, guiding a team and ensuring members receive appropriate and timely care across the organization. The role emphasizes quality, compliance, audits, staff...Work at office3 days per week
- Med-Metrix seeks a Project Manager, Utilization Review to provide operational and analytical support to end-to-end UR clients. You will oversee implementation coordination, stakeholder management, and utilization data analysis with a focus on HIPAA compliant handling of...
- INTEGRIS Baptist Medical Center in Oklahoma City, OK is seeking a day shift/variable, full-time RN Case Manager - Utilization Review. You will assess patients, coordinate transfers, and develop discharge plans to optimize resources and patient outcomes. Qualifications include...Full timeDay shift
- ...care needs across the continuum. Analyzes comprehensive information pertinent to the patient’s care and management to determine nursing diagnosis. Continually utilizes the nursing process to evaluate patient’s progress towards goals and applies appropriate interventions...Temporary workWork experience placementLive outWorldwideFlexible hoursWeekend work
- ...USA Seeking a compassionate Registered Nurse (RN) for our After-Hours Hospice team. Perform... ...admissions, patient visits, symptom management, and care coordination while enjoying a... .... Provides professional nursing care by utilizing all elements of the nursing process....Summer holidayLocal areaMonday to FridayWeekend workDay shift
- ...Overview: Sentara is hiring a Registered Nurse (RN) at Norfolk General Hospital's... ...research, quality, evaluation, resource utilization, and environmental health) encompass the... ...the use of walkie talkies, including the management team. We are ALL invested and willing to...Full timeTemporary workLive outRemote workRelocationRelocation packageShift workDay shift
- PURPOSE AND SCOPE: Works with the Facility Manager, facility staff and physician to... ...policies, procedures and training. Provides nursing support to patients and staff. Assists with... ...manner and the facility capacity is utilized efficiently. As needed, assist with patient...Work at officeLocal areaImmediate start
$28.46 - $38.78 per hour
...and Human Services (DHHS) Public Health Nurse I Opening Date: August 14, 2026 Closing... ...communicable disease control, lead poisoning management, asthma management, immunizations, and... ...members of your family are ill, utilize 12 days of sick leave per year. Health Insurance...Hourly payPermanent employmentFull timeSeasonal workWork at officeImmediate startRemote workMonday to FridayFlexible hours
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