2w
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Utilization Management Nurse
Annapolis or Lanham
$34-$55/hr HybridFull Time
3+ YOECurrent Maryland RN license, BSN (or ADN with equivalent experience; BSN to be completed within 5 years), 3 years acute care nursing, chart review and utilization management experience, EPIC proficiency.
EPIC
2w
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Utilization Management Nurse
Nashville, Tennessee, United States
OnsiteFull Time
3+ YOEPerform prospective/concurrent/retrospective utilization reviews, analyze trends, collaborate with providers, and document reviews; RN license and 3+ years utilization management experience required.
1mo
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Utilization Management Nurse Registered
Woodland Park or Paterson
$49-$74/hr OnsiteFull Time
3+ YOEBachelor of Science in Nursing, NJ RN license, minimum 3 years nursing experience; 3+ years utilization review or case management preferred; CCM preferred.
1d
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Utilization Management Nurse
Dalton, Georgia, United States
OnsiteFull Time
3+ YOECurrent compact RN license, clinical and utilization review experience, Microsoft Office proficiency, NCQA knowledge preferred, ability to manage priorities and interpret medical policy and benefits.
Microsoft Outlook, Microsoft Word, Microsoft Excel
3w
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Utilization Management Nurse
Chapel Hill, North Carolina, United States
RemoteFull Time
2+ YOEActive RN licensure required, 2+ years UM team experience in managed care, BLS not explicitly stated; proficiency with Microsoft Office, MCG and CMS criteria, utilization review and benefit interpretation skills.
Microsoft Outlook, Microsoft Word, Microsoft Excel, Microsoft PowerPoint, MCG, CMS
4w
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Utilization Management Nurse
Wilmington, Delaware, United States
HybridFull Time
5+ YOEBSN and active DE RN license required, 5+ years related experience, conducts concurrent utilization reviews, ensures regulatory compliance and coordinates interdisciplinary care using EMR.
EMR
1d
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Contract Utilization Management Nurse
United States
$42/hr RemoteFull Time
3+ YOEActive RN license, 3–5 years utilization management experience, experience in risk-based integrated care, data-driven decision making, strong communication and leadership skills.
1mo
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Utilization Management Nurse, LVN/LPN
California, United States
$26-$40/hr OnsiteFull Time
2+ YOEActive California RN or LVN/LPN license required; 2+ years clinical nursing experience (1+ year in utilization review/case management preferred); CPUR/CCM/ACM preferred; proficiency with InterQual, MCG, EHR, and Microsoft Office.
InterQual, MCG, Electronic Health Records (EHR), utilization management software, Microsoft Office Suite
5d
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Utilization Management Nurse Consultant
Missouri, United States
$26-$56/hr RemoteFull Time
2+ YOEActive unrestricted RN license,2+ years adult acute/critical care experience,Associates Degree in Nursing required,BSN preferred,BLS/CPR implied,ability to work remote in CST/MT,time-management and clinical judgment skills.
3w
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Utilization Management Nurse, Senior
El Dorado Hills or California or Long Beach or Lodi or Oakland or Rancho Cordova or Redding or San Diego or Woodland Hills
$91k-$154k/yr HybridFull Time
5+ YOEAssociate Degree in Nursing required, active unrestricted RN license (or ability to obtain additional state licenses within 90 days), 5+ years relevant experience in managed care or clinical setting, BLS preferred, ability to work rotating on-call/evening/weekend schedule.
4d
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Utilization Management Nurse
Dubuque, Iowa, United States
HybridFull Time
Active RN with clinical experience (ER/ICU/mental health/orthopedics/pain preferred), strong multitasking, telephonic provider interaction, and ability to apply evidence-based guidelines.
3mo
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Utilization Management Nurse
United States
RemoteFull Time
Active nursing license in good standing; prior authorization and UM expert; NCQA and InterQual experience preferred; Facets experience preferred.
NCQA, InterQual, Facets
6d
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Utilization Management Nurse, LVN - Casual
California, United States
$36-$43/hr RemoteContract
2+ YOECalifornia LVN required, 2 years recent relevant experience, familiarity with utilization review, MCG/InterQual and coding (ICD-10,CPT,HCPCS) preferred, knowledge of payer systems and prior authorization processes.
MCG, InterQual, ICD-10, CPT, HCPCS, Tapestry
2d
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Utilization Management Nurse (RN)
Oklahoma City, Oklahoma, United States
HybridFull Time
2+ YOEActive multi-state or Oklahoma RN license, 2+ years acute care experience, BLS/CPR (implied), strong clinical review, data analysis, communication, and discharge planning skills.
Microsoft Word, Microsoft Excel, Microsoft Access
1mo
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Supervisor Utilization Management
Lewiston or Salt Lake City or Renton or Medford or Portland or Boise or Spokane or Burlington or Fargo or Vancouver
$81k-$142k/yr HybridFull Time
5+ YOE3+ MgmtBachelor's in nursing or related, current unrestricted RN license, 5+ years clinical experience, 3+ years leadership, state license/certification allowing assessments, clinical utilization management competency.
1w
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Utilization Management CoordinatorNE
Glen Burnie, Maryland, United States
$41-$61/hr OnsitePart Time
3+ YOEActive Maryland RN license, graduation from accredited nursing program, BSN preferred, 3 years clinical experience, knowledge of utilization review and case management, ongoing professional development.
1mo
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Manager- Utilization Management
Greenville, North Carolina, United States
$92k-$134k/yr OnsiteFull Time
3+ YOEBachelor's degree in nursing, 3+ years related experience, experience with utilization review, regulatory compliance, and clinical decision tools (MCG/InterQual).
MCG, InterQual
2mo
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TIHP Utilization Management Nurse (84124)
Victoria, Texas, United States
OnsiteFull Time
2+ YOERN or LVN with 2+ years Utilization Management and 5+ years acute clinical experience; proficient with MS Office; experience with MCG/InterQual; Texas licensure required or compact license.
Microsoft Office (Word, Excel, Outlook), MCG InterQual
3mo
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Utilization Management Nurse II - Case Management
Coushatta, Louisiana, United States
OnsiteFull Time
2+ YOERN/LPN with years of utilization management experience; case management certification preferred; strong communication and regulatory knowledge.
InterQual, MCG, CMS Inpatient List, HIPAA
6d
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Appeals Utilization Management Nurse - St. Luke's Health Plan
Boise, Idaho, United States
OnsiteFull Time
3+ YOEActive Idaho RN license, BLS/CPR typical, 3+ years nursing experience (BSN) or 5+ years (ASN); strong written/verbal communication and critical thinking; experience with appeals and utilization review preferred.
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