Utilization Management Nurse
ChenMed
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. The ideal candidate holds an MD with Internal Medicine or Family Practice training, a Pain Management board, and 1–2 years in hospital medicine or utilization review. Strong analytical and communication skills are essential. #J-18808-Ljbffr
Vacancy posted 4 days ago
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New York, NY3 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
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New York, NY3 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
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New York, NY3 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-...Suggested
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New York, NY1 day 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
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New York, NY4 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 hour 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$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- 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...Remote jobWork at office
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- 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
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...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
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New York, NY2 hours 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, NY3 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
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New York, NY1 day 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
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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
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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$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- ...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
The Judge Group, LLC
New York, NY1 day ago - 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
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Join Personify Health as an RN Utilization Management Team Lead, where you will provide clinical and operational leadership in a dynamic environment. With a strong emphasis on compliance and quality, you will support timely coverage determinations and enhance team performance...Hourly pay- A healthcare solutions company is seeking a Utilization Management Nurse Reviewer to assess the appropriateness of medical services and collaborate with healthcare professionals. This role requires a Licensed Practical/Vocational Nurse with clinical experience and skills...
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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$2,041.02 per week
...Summary: Provides safe, high-quality nursing care for telemetry patients by applying... ...interdisciplinary team to deliver comprehensive patient management and education. Responsibilities:... ...Assess and evaluate patient conditions, utilizing critical thinking to develop and modify...TactStaff
New York, NY43 minutes ago
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