RN Utilization Management Specialist
Socket
Dane Street is seeking a Utilization Management Nurse Reviewer to ensure medical services are used efficiently and appropriately. The role involves reviewing records, coordinating care, and making evidence-based recommendations within URAC and state guidelines. Required is an active nursing license (LVN/LPN or RN) with 2+ years clinical experience and 1 year in utilization management. Strong communication and multitasking abilities are essential for this fast-paced environment. #J-18808-Ljbffr
- ...SSM Health in the United States seeks a registered nurse for utilization management to evaluate medical necessity of hospital admissions and procedures... ...role supports day shift operations, requires two years of RN experience, and involves coordinating with payors, physicians...SuggestedRemote workDay shift
- ...Humana Healthy Horizons in Kentucky seeks a Utilization Management Behavioral Health Professional 2 to support coordination, documentation, and communication of medical services and benefit determinations. The role requires interpreting criteria and policies with independent...Suggested
$50k
...Employer Industry: Behavioral Healthcare Management Why consider this job opportunity Starting pay up to $50,000 per year, based on... ...Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary treatment...SuggestedRemote work- ...Role summary Congress Billing is a Billing Management Company focused on providing low-cost RCM solutions to maximize insurance... ...quickly and efficiently. They are seeking a Utilization Review Specialist to join their remote team. This role is responsible for performing...SuggestedRemote work
- ...stakeholders, including physicians and Care Coordination staff, to support patient admissions. Candidates must have a valid California RN license and at least two years of clinical experience or a Master's degree in a related field. The position offers remote work with...SuggestedRemote work
$42 per hour
...Registered Nurse (RN) - Telehealth Medicare Annual Wellness Visit Specialist - PRN Full-time WHO IS GUIDEHEALTH? Guidehealthis... ...Healthguides™ and a centralized Managed Service Organization to build... ...risk factors for chronic diseases, utilizing remote monitoring tools when...Bi-weekly payFull timeTemporary workFor contractorsReliefLocal areaRemote workWork from homeMonday to Friday- ...Coronis Health is seeking a remote Utilization Review Specialist to manage treatment authorization for behavioral health and substance abuse, interfacing with insurance and managed care entities. The role covers pre-certification, concurrent reviews, and appeals with a...Remote work
- ...seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case... ...This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license.... ...in clinical practice and knowledge of Utilization Review Guidelines. The position offers...Remote work
- 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
- ...Director of Utilization Review Under the direction of the Director of Utilization Review, the Specialist will coordinate Medicaid Managed Care authorizations and re-authorizations for clients receiving behavioral healthcare services from Odyssey House's Part 820 residential...Temporary workFlexible hours
- ...Santa Barbara Cottage Hospital is seeking a Per Diem RN for Utilization Management Review. This role offers the flexibility of remote work and requires a valid MA Registered Nurse State License. The successful candidate will participate in ensuring quality patient care...Daily paidRemote work
- ...Description Utilization Management Specialist MSH Case Management FT Days EOW This position is responsible for coordinating requests for clinical information from third party payers and providing support to a broad client base, both internal and external to the institution...Hourly payTraineeshipWork at officeLocal area
- ...coordinating, integrating, and monitoring the utilization of behavioral health (BH) or physical... .... Refer to and work closely with Case Management to address member needs. Participates in... ...Levels Associates degree and active NYS RN license required. Bachelors degree...Full timeContract workWork at officeRemote work
$83k - $120k
...and satisfy all regulatory requirements. Utilization Review & Triple-Check Coordination:Lead the... ...to validate medical necessity, track managed care authorizations, and ensure accurate... ...:Current, unrestricted Registered Nurse (RN) license in the state of practice. MDS Experience...Full timeTemporary workPart timeWork at officeImmediate startFlexible hoursShift work- ...Osmose Utilities is seeking to fill multiple Safety Specialist1 roles; must live in one... ...growing company and safety team, the Safety Specialist I will work/travel within their... ...performance and support the Osmose Safety Management Program. On a daily basis, the Safety Specialist...For subcontractorLive inNight shift
$33.72 - $47.19 per hour
...Position Type: Administrative Services/ Fleet Management Asset Specialist Date Posted: 7/14/2026 Location: New Civic Center Closing Date: 07/28... ...Computerized Fleet Analysis (C.F.A.) or any other program that is utilized for management of the City's Fleet assets. This role also...Work experience placementWork at office$35.5k - $57.5k
...Overview In this dynamic role, the successful candidate will directly manage day‑to‑day social media presence by generating, editing,... ...quarterly social metrics to measure the effectiveness of our efforts. Utilizes data located in Databricks to create quarterly scorecard on our...Local area$64.25k - $72k
...trimming trees — we’re building a future. As the second-largest utility vegetation management company in North America and a proud employee-owned... ...Plan (ESOP)! Responsibilities What You’ll Do as a Safety Specialist Serve as a visible leader, influencing and motivating...ApprenticeshipLocal areaNight shiftDay shift- ...would like in-person up front NYC for onboarding. Role Specialist - Revenue Growth Management Job Description Works under the Director of RGM, Oral Care... ...to develop, lead, and translate strategy into action, utilizing a compelling narrative, motivating others, setting...Hourly payFull timeImmediate startRemote work
- ...Summary The PAHub & Prior Authorization Specialist serves as a trusted consultant to... ...customer operations, implementation, account management, training, and support. The ideal... ...Adoption & Optimization Assess customer utilization of PAHub and identify opportunities for...Local areaRemote work
- ...Medtronic. He watched clinicians struggle to manage these sophisticated devices using... .... About The Role The Patient Experience Specialist plays a key role in supporting patients... ...list and act on lost or follow‑up patients utilizing Murj Data Analytics tools Understand cardiac...Remote workFlexible hours
- ...currently competent in word processing, spreadsheets and database management, the individual must become within six months of employment.... ...office training. Organized project management skills and utilize researched tools to present project initiatives (can use industry...Work at office
- ...part of a dynamic team at the forefront of subscription spend management innovation? At TRG Screen, we’re not just redefining how organizations... ...and make a meaningful impact on the way businesses access and utilize critical information. At TRG Screen, your talent and ambition...Remote workWorldwide
$22 per hour
...services, and to take advantage of internal opportunities at IST Management for training and development toward advancement into... ...Please respect individuals reaching out for accommodations by utilizing the contact information only for this purpose. You will receive...Hourly payWork at officeLocal areaNight shift- ...Wealth Enhancement is an independent wealth management firm dedicated to enriching the lives... ...services. Position Overview Facilities Specialist (Fully Remote). Base salary range $80,0... ...and improve branch office space utilization efficiency Establish processes and communications...Full timeContract workTemporary workWork at officeRemote workRelocationFlexible hours
$20 - $30 per hour
...A behavioral healthcare organization is seeking a Utilization Review Specialist to conduct clinical auditing and negotiate authorizations. The ideal candidate has a Bachelor's degree in Social Work or Nursing and 1-2 years of healthcare experience. Responsibilities include...- ...Humana Inc. is seeking a Health Services Lead to oversee the design, implementation, and sustainability of Utilization Management clinical programs. You will ensure clinical integrity, regulatory alignment, and governance across markets while standardizing national UM...Remote work
$20 per hour
...responded to in ways that fully develop and utilize each person's talent and strengths. Position Per Diem Peer Specialist - NYC Full-Time/Part-Time Per Diem... ...Specialist to work with our Crisis Incident Stress Management (CISM) team to provide support to tenants...Daily paidFull timePart timeInternshipLive inLocal areaFlexible hoursDay shiftAfternoon shift- ...University Wexner Medical Center is seeking a Clinical Finance Case Manager - RN to secure complex pre-authorizations and prevent denials. You... ...for assigned payers, with responsibilities spanning Appeals, Utilization Management, and collaboration with Legal and Medical...
- ...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
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