• Registered Nurse Care Manager - McLaren…

    McLaren Health Care (Bay City, MI)
    …barriers to D/C). 4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers. 5. ... **Three years of acute hospital care experience** _Preferred:_ + Experience in utilization management /case management , critical care, or patient… more
    McLaren Health Care (01/02/26)
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  • Utilization Review Denials…

    UNC Health Care (Kinston, NC)
    …applied clinical experience as a Registered Nurse required. + 2 years utilization review , care management , or compliance experience preferred. + Minimum ... to support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying… more
    UNC Health Care (11/20/25)
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  • Registered Nurse - Utilization

    Cedars-Sinai (Los Angeles, CA)
    …has named us one of America's Best Hospitals. Summary of Essential Duties: + The Utilization Management (UM) Registered Nurse - Medicare Short Stay & ... Coordination **Req ID** : 14355 **Working Title** : Registered Nurse - Utilization Review Case Manager... Case Manager - 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical… more
    Cedars-Sinai (01/02/26)
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  • UM Clinical Reviewer

    Centers Plan for Healthy Living (Margate, FL)
    …accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary ... care or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests… more
    Centers Plan for Healthy Living (10/14/25)
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  • Clinical Reviewer , Nurse (Medical…

    Evolent (Lansing, MI)
    …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
    Evolent (12/10/25)
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  • Surgical Clinical Reviewer - General…

    Hartford HealthCare (Hartford, CT)
    …The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation, ... over the course of the patient's care through effective utilization of the hospital and surgeons' office record systems....departments, and others whose support is necessary for the management and success for the program. . Serves as… more
    Hartford HealthCare (12/29/25)
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  • Quality Systems Reviewer

    Nuvance Health (Poughkeepsie, NY)
    …Team Leaders via program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as ... *Description* Summary: *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement, Risk Management ,… more
    Nuvance Health (01/04/26)
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  • Utilization Review Nurse

    The County of Los Angeles (Los Angeles, CA)
    …may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience whose primary charge is ... UTILIZATION REVIEW NURSE SUPERVISOR I Print...of Los Angeles, a Utilization Review Nurse is an RN that has Case Management more
    The County of Los Angeles (12/25/25)
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  • Senior Medical Management Nurse

    Ventura County (Ventura, CA)
    …the Senior Medical Management Nurse is responsible for performing utilization review , case management , and quality improvement functions to ensure ... Senior Medical Management Nurse - VCHCP Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5113983)..., Disease Management , Quality Assurance, HEDIS and/or Utilization Review . NECESSARY SPECIAL REQUIREMENTS + Must… more
    Ventura County (12/07/25)
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  • Quality/ Utilization Review

    George C. Grape Community Hospital (Hamburg, IA)
    Quality/ Utilization Review Nurse Position Summary: The Quality/ Utilization Review Nurse is responsible for evaluating the medical necessity, ... years of clinical nursing experience (acute care preferred). o Prior experience in utilization review , case management , quality improvement, and infection… more
    George C. Grape Community Hospital (11/25/25)
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