Average salary: $72,771 /yearly
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$72.8k - $130k
...collaborative team scheduling and there is an occasional opportunity for remote work based on business needs. As a Sr Utilization Management Nurse in the Springfield MA Regional Area, the role centers on ensuring the accuracy of medical record coding, supporting...SuggestedMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal areaRemote workOptum
Charlton, MA1 day ago- ...The Utilization Management (UM) Nurse is a licensed nursing professional responsible for reviewing UM cases and discharge planning activities. The UM Nurse may also assist with preparing files for audits and required reporting and ensuring UM cases are reviewed and processed...SuggestedFull timeWork at officeRemote work
North East Medical Services
Burlingame, CA5 days ago - ...Utilization Management Nurse BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit...SuggestedContract workWork at officeRemote work
MagnaCare
Chapel Hill, NC2 days ago - ...Job Title Utilization Management Team Leader Job Description The Utilization Management team independently manages complex utilization... ...Your knowledge and experience: ~ Associate Degree in Nursing required ~ Bachelor of Science in Nursing or advanced...SuggestedFull timeContract workPart timeWork at officeLocal areaWork from homeHome officeWeekend workAfternoon shift2 days per week
Blue Shield Of California
Woodland Hills, CA3 days ago - ...Utilization Management Registered Nurse (UM RN) 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...SuggestedRemote work
Appworks
United States1 day ago $70k - $75k
...Utilization Management Registered Nurse (RN) - Remote The Utilization Management Registered Nurse is responsible for performing utilization review activities in compliance with federal and state regulations, URAC standards, and Guidehealth policies. This role applies...SuggestedBi-weekly payFull timeTemporary workFor contractorsLocal areaRemote workWork from homeGuidehealth
United States1 day ago- ...Humana is seeking a Utilization Management Nurse to support coordination, documentation, and communication of medical services and benefit determinations. This role suits experienced nurses who can work independently and make critical patient-care decisions. This full...SuggestedFull timeRemote work
Humana
United States4 days ago - ...and military-connected families, with enterprise discipline in service to those who served. Position Overview The Nurse Reviewer, Utilization Management performs prospective, concurrent, and retrospective medical necessity review of requested services to ensure members...SuggestedFull timeLocal areaRemote work
BrightonONE
Boston, MA5 days ago $37.2 - $50.4 per hour
...Who We Are Looking For Every day, Cambia’s dedicated team of Nurses are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Utilization Management Nurses provide utilization management (such as prospective...SuggestedFull timeWork at officeImmediate startWork from homeFlexible hoursCambia Health Solutions
Tacoma, WA3 days ago- Mass General Brigham Health Plan Holding Company, Inc. seeks a Nurse for utilization review to assess medical necessity and benefit coverage for ACO/HMO/EPO members. Remote with occasional on-site team meetings in Somerville, MA. Strong InterQual/Milliman experience and...SuggestedRemote work
Mass General Brigham
Somerville, MA2 days ago - ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge planning and utilization review.Responsibilities:• Reviews admissions and service requests within...SuggestedRemote work
3B Healthcare
Austin, TX2 days ago $60.15 - $85.81 per day
...Utilization Management NurseThe Utilization Management Nurse supports the case management department by providing a variety of utilization management functions including but not limited to daily screening of patient admission relative to specified criteria, active involvement...SuggestedFull timeWork experience placementRemote workWork from homeShift workCredenza Health
Madera, CA11 hours ago- ...Cambia Health Solutions, Inc. is seeking a Utilization Management Nurse to join our Clinical Services team. This remote role supports members in Oregon, Washington, Idaho or Utah, conducting prospective, concurrent and retrospective reviews to ensure medical necessity...SuggestedRemote work
Cambia Health Solutions
United States2 days ago - ...Cambia Health Solutions seeks an Utilization Management Nurse to conduct reviews (prospective, concurrent, retrospective) and ensure medical necessity and policy compliance. You will consult with physician advisors and collaborate with interdisciplinary teams to improve...SuggestedRemote work
Cambia Health Solutions
United States4 days ago - ...Utilization Management Department (Fully Remote) Provides health care services regarding admissions, case management, discharge planning and utilization review. Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective...SuggestedRemote work
3B Healthcare, Inc.
United States3 days ago $26.01 - $68.55 per hour
...community at a time. Position Summary Utilizes clinical experience and skills in a... ...administration of the utilization/benefit management function. Typical office working... ...active current and unrestricted Registered Nurse (RN) licensure in state of residence ~...Hourly payFull timeTemporary workWork at officeLocal areaWork from homeWeekend workAfternoon shiftCVS Health
Mountain Home, UT2 days ago$45 per hour
...Job Description Job Description Utilization Management Nurse Coordinator (RN or LVN) needed for a temp 6+ month, remote contract opportunity with Yoh’s managed care health plan client based out of Redding or Fairfield, CA. Anticipating to be temporary for at least...Contract workTemporary workRemote workMonday to FridayWeekend workYoh, A Day & Zimmermann Company
Redding, CA15 days ago$29.1 - $62.32 per hour
...bigger - helping to simplify health care one person, one family and one community at a time. Position Summary This Utilization Management Nurse Consultant (UMNC) position is 100% remote. As a Utilization Nurse Consultant, you will utilize clinical skills to...Hourly payFull timeTemporary workWork at officeLocal areaRemote workMonday to FridayCVS Health
Richmond, VA2 days ago- ...CVS Health is seeking a Utilization Management Nurse Consultant for a fully remote position. You will review medical necessity, facilitate discharge planning, and collaborate with providers to support members with complex needs. Qualifications include ADN required,...Remote work
CVS Health
United States5 days ago $32.01 - $68.55 per hour
## Utilization Management Nurse ConsultantApply: Remote: IL - Work from home: Work At Home-Ohio: Work At Home-Texas: Work At Home-Georgia: Work At Home-West Virginia: Full time: Posted Today: End Date: October 11, 2026 (4 days left to apply): R1047682We’re building a world...Hourly payFull timeTemporary workWork at officeRemote workWork from homeMonday to FridayAfternoon shiftCVS Health
Eastern, KY2 days ago- ...CVS Health is seeking an experienced Utilization Management Nurse Consultant to apply clinical judgment and guidelines to determine appropriate benefits across the continuum of care. This full-time role supports a 24/7 operation, with scheduled weekends, holidays and...Full timeRemote workWeekend workAfternoon shift
4062 Aetna Resources, LLC
United States2 days ago $1,600 - $1,800 per week
...NOW HIRING: Registered Nurse - Utilization Management Location: Buckley AFB & Peterson AFB, Colorado Military Health System Compensation: $1,600 - $1,800/week (based on experience) Contract Length: 1-year minimum (Current POP ends 11/30/25, TO POP...Contract workImmediate startRemote workMonday to FridayVarite
Aurora, CO1 day ago- ...CVS Health Corporation is seeking a Nurse Consultant to join our Utilization Management team. The role focuses on applying clinical judgment and evidence-based criteria to review inpatient and outpatient services, authorizing care, and escalating cases when needed....Remote work
CVS Health
United States2 days ago $32.01 - $68.55 per hour
...something bigger – helping to simplify health care one person, one family and one community at a time. Registered Nurse (RN) – Utilization Management Join a dynamic healthcare team and make an impact on patient care from wherever you work. We are seeking an experienced...Hourly payFull timeTemporary workWork experience placementWork at officeLocal areaWork from homeAfternoon shift4062 Aetna Resources, LLC
New York, NY2 days ago- ...CVS Health Corporation is seeking a Utilization Management Nurse Consultant in the United States to apply clinical judgment and coordinate care across the continuum for members. This role supports a 24/7 operation with weekend and evening hours and requires strong communication...Remote workWeekend workAfternoon shift
CVS Health
Little Rock, AR4 days ago - ...CVS Health Corporation in Springfield, IL is hiring a Utilization Management Nurse Consultant to assess and coordinate care, applying clinical criteria to determine coverage and benefits for members. This is a 24/7 operation with weekend, holiday and evening hours....Remote workShift workWeekend workAfternoon shift
CVS Health
United States5 days ago $60k
...is looking for a LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual... ...: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse’s responsibilities include but are not limited...Temporary workLocal areaRemote workIntegra Partners
Troy, MI4 days ago$29.1 - $62.32 per hour
...Utilization Management Nurse Consultant Clinical Precertification RN (Medicare)Remote | Full-Time | Weekday ScheduleAre you a Registered Nurse ready to make an impact beyond the bedside? Join our team and use your clinical expertise to ensure members receive the right...Hourly payFull timeTemporary workWork at officeRemote workWork from homeMonday to FridayAfternoon shiftWeekday workCVS Corporation
Philadelphia, PA11 hours ago- ...CVS Health is hiring a Nurse Consultant for a 100% remote Utilization Management role. You will apply clinical judgment to review inpatient and outpatient services, authorize care, and collaborate with providers while maintaining precise documentation. The position...Remote workFlexible hours
Pennsylvania Psychological Association
Phoenix, AZ2 days ago $59.5k - $116.6k
...UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services and requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote workWeekend workkozmetickesluzby.vecnakraska.sk - Jobboard
United States4 days ago
