Average salary: $72,771 /yearly
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- ...About The Role 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 coverage while...SuggestedContract workWork at officeRemote work
Brighton Health Plan Solutions
United States1 day ago $71.1k - $97.8k
...Become a part of our caring community The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report...SuggestedBi-weekly payFull timeTemporary workApprenticeshipWork at officeRemote workHome officeHumana
United States4 days ago$71.1k - $97.8k
...Become a part of our caring community The Part C Grievance & Appeals (G&A) Nurse (Utilization Management Nurse 2) utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations...SuggestedFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeFlexible hoursWeekend workWeekday workHumana
Olympia, WA3 days ago$80k - $95k
...Utilization Management Nurse IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care, strengthen financial performance, and stay compliant. IntusCare replaces outdated...SuggestedRemote workIntus Care
United States20 hours ago- ...Utilization Management Specialist Shift: Monday through Friday 8:00 AM to 4:30 PM, with every fifth weekend rotation. Contract Length:... ...accepted. Client Details City Fort Myers State FL TLC Nursing Associates, Inc. is an equal-opportunity employer and fully...SuggestedContract workWork experience placementLocal areaRemote workMonday to FridayShift workWeekend work
Lee Health-Corporate Center
Fort Myers, FL1 day 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 States3 days ago $70k - $75k
...embedded Healthguides™ and a centralized Managed Service Organization to build stronger... ...path!! Job Description The Utilization Management Registered Nurseis responsible... ...and education consistent with current nursing practice standards and the Illinois Nurse...SuggestedBi-weekly payFull timeTemporary workFor contractorsLocal areaRemote workWork from home$29.1 - $62.32 per hour
...Join Our Utilization Management Team We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose...SuggestedFull timeRemote workShift workAfternoon shiftOak St. Health
United States2 days ago$29.1 - $62.32 per hour
...simplify health care one person, one family and one community at a time. Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours. UM Nurse Consultant Fully Remote- WFH Schedule: Monday, Tuesday, Thursday,...SuggestedHourly payFull timeTemporary workWork at officeLocal areaRemote workWork from homeMonday to FridayAfternoon shiftCVS Health
United States20 hours ago$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 Boston MA Regional Area, the role centers on ensuring the accuracy of medical record coding, supporting proper payment...SuggestedMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal areaRemote work$29 - $52 per hour
...Utilization Review Nurse, RN Optum is a global organization that delivers care, aided by technology to help millions of people live healthier... ...clinically efficient and effective Inpatient utilization management. Reviews inpatient criteria for acute hospital admissions...SuggestedRemote jobHourly payMinimum wageFull timeWork experience placementLocal areaMonday to FridayShift work- ...JOB SUMMARY The Utilization Management (UM) Prior Authorization (PA) Nurse is a full-time role with NeueHealth, dedicated to promoting quality and cost-effective outcomes for the designated population. Working in collaboration with Medical Directors and the clinical...SuggestedFull timeContract workWork at office
NeueHealth
Remote12 days ago $50.1 - $75.1 per hour
...Neighborhood Healthcare PACE Nurse Navigator/Liaison Community health is about more... ...Together. Neighborhood Healthcare PACE is a managed medical plan built around surrounding... ...over 650 senior participants. The Utilization Management (UM) and Transitional Care...SuggestedHourly payLocal areaRelocation packageMonday to Friday$60.2k - $107.4k
...Utilization Management Nurse Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits...SuggestedRemote jobMinimum wageFull timeWork experience placementLocal areaMonday to FridayFlexible hoursWeekend workAfternoon shift- ...Job Description The Utilization Review Case Manager is responsible for assessing the medical necessity, appropriateness, and efficiency of patient... ...escalation policies. Uses clinical knowledge and nursing expertise to conduct initial and concurrent reviews for inpatient...SuggestedRemote workShift workNight shift
$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 States1 day ago$26.01 - $68.55 per hour
...time. Fully remote with requirement to work the following schedule: Monday-Friday 8:00am-4:30pm EST. Position Summary As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/...Hourly payFull timeTemporary workWork at officeLocal areaRemote workMonday to FridayWeekend workIshe
Brooklyn, NY1 day ago$26.01 - $56.14 per hour
...Utilization Management Position We're building a world of health around every individual — shaping a more connected, convenient and compassionate... ...Qualifications 2+ years of experience as a Registered Nurse in adult acute care/critical care setting Must have...Hourly payFull timeTemporary workWork at officeRemote workWork from homeAfternoon shiftOak St. Health
United States1 day ago$29.1 - $62.32 per hour
...schedules will be determined in collaboration with management to ensure adequate weekend coverage. Position Summary Utilize your clinical experience and skills in a... ...as directed. Required Qualifications Registered Nurse Education: Diploma RN acceptable; Associate degree...Hourly payFull timeTemporary workWork at officeLocal areaWork from homeShift workWeekend workCVS Health
New York, NY2 hours agonew$26.35 - $39.53 per hour
...better care experience for all. Job Summary: The Concurrent Utilization Review (UR) Nurse is responsible for conducting real-time clinical reviews... ...appropriateness of healthcare services provided to members under a managed care health plan. This role involves assessing inpatient...Hourly payWork at officeRemote workNeueHealth
California, MO2 hours agonew- 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
- System One is seeking an Utilization Management Specialist (RN) for a contract-to-hire role based in Baltimore, MD. The position is remote-offsite with responsibilities for reviewing medical necessity and coordinating care. You will analyze clinical information, collaborate...Remote jobContract work
$81.12k - $115.94k
...MD. Facility: Ascension Saint Agnes Hospital Department: Utilization Management Schedule: Day-Shift | Full-Time Salary: $81,120.00- $115,9... ...Need Licensure / Certification / Registration: Registered Nurse credentialed from the Maryland Board of Nursing obtained prior...Full timeTemporary workLocal areaRemote workDay shift- Humana is seeking a Utilization Management Nurse 2 to apply clinical nursing skills in coordinating, documenting and communicating medical services and benefit determinations. This remote role may require occasional travel to Humana's offices for training or meetings....Remote job
$45 - $45.5 per hour
Overview Job Title: Nurse Case Management Senior Analyst Location: REMOTE Duration: 5-6 Months (Contract possibly Extension) Schedule: Monday... ...services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, coordinate,...Contract workImmediate startRemote workMonday to FridayAfternoon shift- 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
- Harris Health System, Inc. is seeking a Utilization Management Review Nurse to evaluate medical necessity, appropriateness, and efficiency of services, ensuring care aligns with evidence-based guidelines. The role involves partnering with Care Management, Physician Advisors...Remote jobFlexible hours
- ...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
- 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 interpreting criteria, following guidelines, coordinating with providers...Remote job
- UnitedHealth Group is seeking a Utilization Management Nurse to ensure efficient and effective health services delivery across care settings. You will assess member needs, determine medical appropriateness, and support clinical decisions to help members live healthier...Remote job
