95 um nurse jobs at 55 companies in United States
2w
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Compliance UM Nurse (Wed - Sun)
Kentucky or Oklahoma or North Dakota or North Carolina or New Mexico or New Jersey or New Hampshire or Nebraska or Montana or Missouri or Mississippi or Maryland or Maine or Louisiana or Kansas or Iowa or Indiana or Idaho or Georgia or Florida or Delaware or Connecticut or Colorado or Arkansas or Arizona or Alabama or Wyoming or Wisconsin or West Virginia or Washington or Virginia or Vermont or Utah or Texas or Tennessee or South Dakota or South Carolina or Pennsylvania
$71k-$98k/yr RemoteFull Time
1+ YOEActive compact RN with no disciplinary action; 3+ years UM OR 2+ years UM auditing OR 1+ year home health UM experience; telephonic/virtual communication skills; Microsoft Word, Outlook, Excel proficiency; ability to work independently; home office internet and privacy requirements.
Microsoft Word, Microsoft Outlook, Microsoft Excel
1mo
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UM Nurse
San Antonio, Texas, United States
OnsiteFull Time
5+ YOEActive RN or LVN license, 5+ years managed care/UM experience, EMR and basic office software proficiency, ability to review medical records, compose denial letters, and meet UM delegation requirements.
EMR, Word processing software, Spreadsheet software, Internet, Database software
1mo
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UM Nurse
San Antonio, Texas, United States
OnsiteFull Time
5+ YOEActive unencumbered RN or state-licensed practical nurse (LVN) with clinical/managed care experience; 5+ years in managed care/UM preferred; EMR and computer proficiency; ability to lift up to 40 lbs and work in clinic/office environment.
EZ Cap, EMR, ODAG, Internet
3w
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UM Nurse, Pre-service (Remote | California RN/LVN License Required | Sun - Thurs | Pacific Time Hours)
United States or California
$78k-$117k/yr RemoteFull Time
3+ YOEActive California RN or LVN license required; 3+ years nursing, 1+ year pre-service UM and managed care experience; familiarity with CMS and Milliman Care Guidelines, ICD-10/CPT, and referral systems; strong communication and clinical judgment.
Milliman Care Guidelines (MCG), ICD-10, CPT, Access Express, N-coder, Microsoft Word, Microsoft Excel, Microsoft Outlook
4w
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Review Nurse-PA/UM
Atlanta, Georgia, United States
HybridFull Time
3+ YOEActive Georgia RN with 3+ years clinical nursing experience, knowledge of ICD-10-CM/CPT and InterQual preferred, typing 30-50 WPM, strong communication and independent clinical judgment.
ICD-10-CM, CPT, InterQual, Microsoft Windows
1mo
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UM Nurse Manager II, Hospital
Downey, California, United States
$213k-$246k/yr OnsiteFull Time
5+ YOE4+ MgmtBSN and active California RN required; 5+ years patient care experience, 5 years business/clinical operations experience, 4+ years leadership; BLS required; PALS and ANCC preferred; experience managing hospital nursing operations.
3w
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Outpatient UM Coordinator
Sherman Oaks, California, United States
$21-$23/hr HybridFull Time
1+ YOEClinical background required (LVN/RN preferred),1-3 years UM/prior authorization experience, knowledge of outpatient terminology,CPT/ICD-10 coding,InterQual/Milliman familiarity,proficient with UM systems and Microsoft Office.
InterQual, Milliman, Microsoft Office Suite, CPT, ICD-10
1w
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REGISTERED NURSE - HOME HOSPICE | UM HEALTH-SPARROW
Lansing, Michigan, United States
FieldFull Time
1+ YOECurrent Michigan RN license, BLS, valid driver\u0002s license and auto insurance; associate degree in nursing required, BSN preferred; 1+ year hospice/home health experience; hospice certification preferred.
3w
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Medical Review Nurse (RN) - UM/Appeals experience
Florida or Long Beach
OnsiteFull Time
2+ YOEActive unrestricted RN license, 2+ years clinical nursing with ≥1 year utilization review or claims review, knowledge of ICD-10/CPT/HCPC, regulatory requirements, and strong analytic and communication skills.
ICD-10, CPT, HCPC, MCG/InterQual, Microsoft Office
1mo
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UM Nurse Reviewer, LVN - Bakersfield 1.2
Bakersfield, California, United States
$31-$54/hr OnsiteFull Time
Universal Healthcare MSO: Provides administrative and management services for medical provider networks.
1+ YOEActive unrestricted California RN or LVN license required, 1+ year managed care experience preferred, proficiency with PC software, knowledge of ICD-10/CPT and InterQual/MCG preferred, strong communication and analytical skills.
ICD-10, CPT, InterQual, MCG, DOFR (Disposition of Financial Responsibility)
1w
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Registered Nurse (RN) Case Manager DCP/UM PRN
Las Cruces, New Mexico, United States
OnsitePart Time
Current state RN license and associate's degree in nursing required; certifications such as InterQual, CCM, or ACM desirable; experience with discharge planning and coordination of community services.
1w
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Registered Nurse (RN) Case Manager DCP/UM PRN
Las Cruces, New Mexico, United States
OnsitePart Time
Current RN license and associate's degree from an accredited nursing school required. CCM or ACM and National Association of Healthcare Professionals or InterQual certification desired.
InterQual
1mo
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COORDINATOR, UM (LVN)
Pomona, California, United States
$36-$51/hr OnsiteFull Time
1+ YOEValid California LVN license, high school diploma/equivalent, 1+ year utilization review or case management/discharge planning experience, knowledge of Milliman Care Guidelines, EMR use, and strong communication and organizational skills.
Milliman Care Guidelines, electronic medical record systems, Microsoft computer applications
1w
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RN Supervisor/UM (All Shifts Available!)
Muncy Valley, Pennsylvania, United States
OnsiteFull Time, Part Time
Valid PA RN or GN license, BCLS (AHA) required, graduate of accredited nursing program, experience in skilled nursing facility, high school diploma or equivalent, ability to perform assessments, documentation, and unit charge duties.
1mo
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Utilization Management (UM) Coordinator
Blue Ash, Ohio, United States
OnsiteFull Time
CommuniCare Health Services: Operates skilled nursing and behavioral health care facilities.
Oversee authorizations and length-of-stay metrics, review documentation for clinical/reimbursement quality, manage transitions of care, develop denial-minimization processes, and facilitate UM team activities. Education in nursing, social work, or behavioral sciences preferred.
2w
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SCO RN UM Reviewer
Boston, Massachusetts, United States
$44-$64/hr RemoteFull Time
5+ YOE5+ years healthcare experience required, 3-5 years health plan experience preferred. Knowledge of prior authorizations, clinical criteria, strong communication, problem solving, and Microsoft Office proficiency; BSN preferred.
Microsoft Office
2w
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Project UM Audit & Documentation Director
United States
FieldFull Time
5+ MgmtBachelor's in nursing or clinical field required; RN/LPC/LCSW/LMFT required; 5+ years supervisory UM/intake experience preferred; payor audit, documentation, appeal, and compliance expertise.
Medhost, Microsoft SharePoint
3w
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UM COORDINATOR IOP
Madera, California, United States
$37-$55/hr OnsiteFull Time
3+ YOECA RN license required; bachelor\u0002s in nursing, psychology, or social work required (master's preferred). 3+ years acute inpatient psychiatric or utilization management experience. Knowledge of DSM-V, payer authorization, appeals, and clinical review processes.
1w
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Unit Manager (UM) - RN
Louisville, Ohio, United States
OnsiteFull Time
Leadership of nursing staff, oversight of resident care plans, regulatory compliance, staffing management, performance coaching, and quality assurance in a skilled nursing setting.
6d
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RN Unit Manager (UM)
Smethport, Pennsylvania, United States
OnsiteFull Time
2+ YOEActive Pennsylvania RN license and 2+ years of nursing experience in long-term care or rehabilitation required; leadership or supervisory experience preferred.
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