• Behavioral Health Utilization Review…

    Actalent (Sunrise, FL)
    Actalent is Hiring a Behavioral Health Utilization Review Nurse Job Description We are seeking a dedicated Utilization Management Nurse (UMN) who ... experience. + Valid Florida Driver's License. + Knowledge of case management and utilization review concepts, including InterQual and Milliman Criteria,… more
    Actalent (10/15/25)
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  • Behavioral Health Utilization Review…

    Actalent (Sunrise, FL)
    Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing ... Qualifications + Valid Florida Driver's License. + Knowledge of case management and utilization review concepts, including InterQual and Milliman Criteria. +… more
    Actalent (10/10/25)
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  • Utilization Management Nurse…

    Omaha Children's Hospital (Omaha, NE)
    …equal opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case ... settings. + Skills in negotiation and problem solving with utilization management . + Should be a creative,...Compact State Licensure Required and + RN-BC - Case Management Nurse Preferred Children's is the very… more
    Omaha Children's Hospital (09/05/25)
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  • Utilization Review Nurse

    UCLA Health (Los Angeles, CA)
    Description The Utilization Review Nurse is part of the Utilization Management Department at the Resnick Neuropsychiatric Hospital, supporting ... license, required + BLS from the ARC or AHA, required. + Prior case management experience, highly desired + Proficient in Microsoft Office UCLA Health welcomes all… more
    UCLA Health (10/23/25)
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  • Utilization Management Nurse

    Insight Global (Campbell, CA)
    …reviewing medical documentation and applying health plan guidelines - Experience with Utilization Management (UM) - Knowledge of commercial, Medicare, and ... Job Description - Review approximately 60 medical authorization requests per day...- Apply specific health plan guidelines and policies - Review clinical notes and identify key medical criteria -… more
    Insight Global (10/16/25)
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  • Utilization Management / Medical…

    Elevance Health (Walnut Creek, CA)
    Utilization Management / Medical Management Nurse - CA (JR169412) **Virtual:** This role enables associates to work virtually full-time, with the ... - 6pm PST. Rotating Weekends and holidays. The **Medical Management Nurse ** is responsible for review...Med/Surg, Critical Care, ER, Telemetry, etc. strongly preferred. + Utilization management / review within managed care… more
    Elevance Health (10/22/25)
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  • SNF Utilization Management RN…

    Humana (Lincoln, NE)
    **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...in an acute care setting + Previous experience in utilization management / utilization review … more
    Humana (09/12/25)
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  • Manager, Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
    Commonwealth Care Alliance (10/02/25)
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  • Utilization Management…

    AmeriHealth Caritas (Washington, DC)
    …BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
    AmeriHealth Caritas (09/01/25)
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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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