• Utilization Review Nurse

    Actalent (Sunrise, FL)
    Utilization Management Nurse !Job Description The ...on department activities as assigned. Essential Skills + Clinical review + Utilization review + ... utilization . Working under the general supervision of the Director and/or Manager/Supervisor of Medical Management, and in collaboration...or LPN License. + Minimum of one year of utilization review experience and discharge planning in… more
    Actalent (08/21/25)
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  • Utilization Review Nurse

    Martin's Point Health Care (Portland, ME)
    …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use...requests (prior authorization, concurrent review , and retrospective review ) for medical necessity referring to Medical Director more
    Martin's Point Health Care (08/22/25)
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  • Registered Nurse Utilization

    LifePoint Health (Louisburg, NC)
    …a valid job field* **Organization:** **Maria Parham Franklin* **Title:** *Registered Nurse Utilization Review Coordinator* **Location:** *NC-Louisburg* ... Registered Nurse (RN) Utilization Review ...Management Department to facilitate timely discharge planning.. Reports to: Director , Case Management What we offer Fundamental to providing… more
    LifePoint Health (08/09/25)
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  • Utilization Review & Chronic Care…

    George C. Grape Community Hospital (Hamburg, IA)
    Utilization Review & Chronic Care Management (CCM) Nurse George C. Grape Community Hospital & Clinics is seeking a full-time Utilization Review & ... About the Role In this position, you'll split your time between: * Hospital Utilization Review - Conduct daily face-to-face rounds with providers to review more
    George C. Grape Community Hospital (08/16/25)
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  • Utilization Review Nurse

    US Tech Solutions (Columbia, SC)
    …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... Friday, 8:30am-5:00pm. **Job Description:** + NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills… more
    US Tech Solutions (07/31/25)
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  • RN- Utilization Review

    Ascension Health (Milwaukee, WI)
    …initiatives. + Develop systems and process for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to ... **Details** + **Department:** Utilization Management + **Schedule:** Full Time, Partially Remote...clients. **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date or job transfer… more
    Ascension Health (08/08/25)
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  • Utilization Management Nurse

    CVS Health (Columbus, OH)
    …of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital role in ... phone, computer, etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Commitment to… more
    CVS Health (08/27/25)
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  • Utilization Review Nurse I

    Centene Corporation (New York, NY)
    …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... appropriateness and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review more
    Centene Corporation (08/02/25)
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  • Utilization Management Nurse

    CVS Health (Boise, ID)
    …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and ... a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and plan language… more
    CVS Health (08/15/25)
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  • Utilization Management Nurse

    Actalent (Sunrise, FL)
    …UMN assists in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ... Actalent is hiring a Utilization Management Nurse ! Job Description The...on department activities as assigned. Essential Skills + Clinical review + Utilization review +… more
    Actalent (08/21/25)
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