Utilization Management RN
$100kYour IT & Corporate Recruiter
Job Posting
Job Information
Date Opened 02/28/2026
Job Type Contract
Industry Health Care
Work Experience 1-3 years
Salary $100,000
Remote Job
Job Description
This is a remote position. 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 functions in alignment with clinical guidelines, plan benefits, regulatory requirements, and accreditation standards. The UM Nurse ensures the delivery of cost-effective, high-quality care for members through a variety of activities including utilization review of inpatient, outpatient, and ancillary services using standardized clinical criteria such as MCG and InterQual. Requirements Candidates must hold an Associate Degree in Nursing and maintain an active, unrestricted Registered Nurse (RN) license in the applicable state or possess a compact license. A minimum of three years of prior experience in utilization management within a health insurance company is required. Strong familiarity with MCG, InterQual, or CMS criteria is essential, as is a working knowledge of UM-related regulatory and accreditation standards such as CMS, NCQA, and URAC. The role requires advanced clinical judgment, critical thinking, and communication skills, along with proficiency in electronic medical records and utilization management systems. Preferred qualifications include a Bachelor's Degree in Nursing and professional certification in Case Management or Utilization Review, such as CCM, CPUR, or CPUM. Experience using UM platforms such as TruCare, GuidingCare, Jiva, or similar systems is desirable, along with previous involvement in appeals, grievances, concurrent review, or behavioral health utilization management. A multistate compact RN license is also preferred.
- ...Where You'll Work The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide... ...Job Summary and Responsibilities As our UM RN (Utilization Management Registered Nurse), you will be responsible for ensuring...SuggestedLocal areaRemote workWork from homeShift workWeekend work
Dignity Health Management Services
United States2 days ago $40.12 - $62.19 per hour
...Utilization Review Nurse RN ~Randallstown, MD ~NORTHWEST HOSPITAL ~NW CARE MANAGEMENT ~Full-time - Day shift - 8:00am-4:30pm ~RN OTHER ~96679 ~$40.12-$62.19 Experience based ~Posted: June 3, 2026 Apply Now Save Job Saved...SuggestedFull timeShift workDay shift- ...Description Job Description Description: The Utilization Review (UR) Nurse Team Lead provides... ...day-to-day oversight of workflow management, quality assurance, staff development, and... ...Current, unrestricted Registered Nurse (RN) license. Minimum five (5) years of...SuggestedWork experience placementWork at officeShift workWeekend work
Brundage Medical Group LLC
Pinellas Park, FL6 days ago $47 per hour
...Job Description Job Description Job Title: RN – Utilization Manager Location: Middleburg Heights, OH Schedule: ~ Full-time, 40 hours/week ~ Five 8-hour shifts (8:00a–4:30p) ~40 hours not guaranteed; may be low-censused up to one 12-hour shift per pay...SuggestedFull timeLocal areaImmediate startShift workTalented Medical Solutions
Middleburg Heights, OH15 days ago$75.3k - $135.4k
...a clinical professional on our Medical Management/Health Services team. Centene is a diversified... .... Supervises day-to-day activities of utilization management team. Monitors and tracks... .... License/Certification: RN - Registered Nurse - State Licensure and...SuggestedFull timePart timeWork at officeRemote workFlexible hoursCentene Corporation
Columbia, MO2 days ago- ...The Medical University of South Carolina invites applications for an RN in Utilization Management within MCP. The role conducts utilization reviews, monitors patient charts, and evaluates care plans to ensure appropriate treatment and insurer approvals. Requirements include...
Medical University of South Carolina
Murrells Inlet, SC3 days ago $67.2k - $85k
...Job Number: 180127, Job Title: BH Utilization Manager RN, Salary: $67,200.00 - $85,000.00 Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,00...Contract workWork experience placementRemote workHarris Health
Houston, TX14 days ago- ...Job Description Job Description Job Summary RN Utilization Manager Talented Medical Solutions Full-time, Contract In-Office | Middleburg Heights, OH, United States Schedule: Full-Time 40 hours per week, 5 (8) hour shifts 8a-4:30p. Start Date:...Full timeContract workWork at officeImmediate startShift work
Talented Medical Solutions
Middleburg Heights, OH15 days ago - ...Job Description Job Description RN Executive Director of Utilization Management and CDI Gainesville, GA As the Executive Director of Utilization Management/CDI, you'll lead efforts to connect clinical excellence with financial strength. In this role, you'll oversee...
Healthcare Recruitment Partners
Gainesville, GA15 days ago $116.3k - $264.6k
...UCLA Outpatient Clinics is looking for an experienced Utilization Management Assistant Director in Los Angeles. In this key leadership role, you will oversee Intensive Case Management and Utilization Management operations, ensuring high-quality patient care across complex...UCLA Outpatient Clinics
Los Angeles, CA1 day ago- ...global organization that delivers care, aided by technology to help millions of people live healthier lives. The Utilization Management and Clinical Validation RN will review patient medical records, extract pertinent details, and craft defensible appeal letters per...Remote job
$39.34 - $56.2 per hour
...Wound Care Utilization Management RN Wound Care Utilization Management RN Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity...Full timeWork at officeRemote workMonday to FridayShift work- Ascension Network Services is hiring a Registered Nurse for Utilization Management in a remote, full-time role. You will review admissions and service... ...planning with the healthcare team. The role requires Texas RN licensure (Compact State preferred) and a nursing diploma....Remote jobFull time
$85.86k - $137.38k
Registered Nurse (RN) - Utilization Management FT Day Shift (Hrs.: 8a-4:30p) - On-site Newark, DE ChristianaCare Hospital in Newark, DE, is seeking a Utilization Management Nurse (RN) with experience with insurance providers such as Aetna and Cigna, along with a background...Work at officeLocal areaDay shift- Luminis Health is seeking an experienced RN to conduct concurrent and retrospective chart reviews, focusing on clinical, financial, and resource utilization. You will coordinate with care teams to reduce delays and denied days, and support discharge planning. Requirements...
$39 - $40 per hour
...0/hr - $40.00/hr Direct message the job poster from The Judge Group Lead Healthcare Recruiter at The Judge Group Utilization Management Registered Nurse (RN) Type: 6-Month Contract W2 Location: Remote - but MUST reside in one of the following states: IL, TX, NM, OK, MT...Daily paidContract workRemote workMonday to FridayShift workWeekend work$35 - $37 per hour
...poster from The Judge Group. Job Title: Remote Registered Nurse (RN) - Temp to Perm Pay Rate: $36-37/hr Start Date: April 7th... ...after their travel assignments. No NPs, whether practicing or not. Utilization Review experience is helpful but not required; critical thinking...Remote jobPermanent employmentFull timeTemporary workMonday to Friday- ChristianaCare Health System in Newark, DE, is seeking a Utilization Management Nurse (RN) for a full-time on-site day shift at the Newark Hospital to evaluate medical necessity and efficiency of care under the applicable health benefits plan. The RN will perform admission...Full timeDay shift
- Utilization Review RN - Providence Health Plaza Utilization Management covers 7 days/week, including holidays. This posting is not for a specific job vacancy. It serves to establish a place for current or future interested applicants to apply for Utilization Review RN...Full timePart timeDay shift
$68.13k - $119.52k
...guidelines and regulatory requirements and manages concurrent and pre-bill denials to... ...concurrent authorizations for in-house patients, utilizing daily commercial authorization reports.... ...and Certifications: Registered Nurse (RN) [Required] Basic Life Support (BLS) [Preferred...Full timeWork experience placementLocal areaShift 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
- Humana is seeking an experienced Utilization Management Nurse 2 to support medical necessity reviews, care coordination, and discharge planning for... ...Louisville office a few times annually; requires Kentucky RN license, 2+ years clinical experience, and 1+ year UM experience...Remote jobWork at officeWork from homeShift work
- Description Utilization Review RN at Providence Health Plaza. Utilization Management covers 7 days/week, including holidays. RN Coordinator-Utilization Review supports the care of the patient through assessment, planning, implementation and evaluation of appropriate services...Local area
- Molina Healthcare seeks an experienced RN to support Arizona Plan clinical member services review processes. The role requires an active AZ RN license and experience with utilization management, prior authorization, and both inpatient and outpatient settings. Remote position...Remote job
- An established industry player in healthcare is seeking a dedicated Utilization Management Nurse to enhance patient care efficiency. In this vital role, you will review patient files and treatment methods, ensuring that every patient receives the necessary treatments and...Relocation package
- ...prospective, concurrent and retrospective activities related to utilization. Monitors documentations for accuracy and clinical compliance... ...Provides timely and thorough case screening to identify case management needs and make appropriate referrals to case managers....Night shift
- A leading healthcare organization is seeking a Care Manager RN for a remote role primarily serving the state of Washington. This per diem position involves crucial utilization management activities, ensuring compliance with payer requirements and regulations. Candidates...Remote jobHourly payDaily paidDay shift
$100.97k - $151.45k
...Utilization Management and Discharge Planning RN Location: San Jose, CA Department: Utilization Management - 510 Employment Duration: full-time Salary Range: $100,968 - $151,451 The expected pay range is based on many factors, such as experience, education...Full timeWork at officeLocal area- A healthcare recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an active RN license and experience with health plan operations. Responsibilities include evaluating healthcare...Remote jobContract work
- Utilization Management Registered Nurse (UM RN) Job Summary We are seeking an experienced and detail-oriented Utilization Management Registered Nurse (UM RN) to join our hospital team. The UM RN is responsible for reviewing patient cases to ensure appropriate utilization...
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