• Director, Healthcare Services; Utilization

    Molina Healthcare (GA)
    …and experience. * At least 3 years health care management /leadership required. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), Licensed ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
    Molina Healthcare (09/19/25)
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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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  • Associate Manager, Clinical Health Services…

    CVS Health (Little Rock, AR)
    …members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the ... needed. + 3+ years inpatient clinical experience as a Registered Nurse . + 3+ years of Managed...years of Managed Care experience. + 3+ years of Utilization Management experience. + 1+ year Leadership… more
    CVS Health (10/15/25)
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  • Utilization Management Nurse

    Omaha Children's Hospital (Omaha, NE)
    management . + Should be a creative, flexible, risk taker. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State ... including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area...Licensure Required and + RN -BC - Case Management Nurse more
    Omaha Children's Hospital (09/05/25)
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  • Director of Case Management

    Prime Healthcare (Inglewood, CA)
    …provides leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and ... Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients… more
    Prime Healthcare (10/18/25)
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  • Director Utilization Management

    Texas Health Resources (Arlington, TX)
    Director Utilization Management -Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... system services for wholly owned and Partner hospitals for utilization management . Job Duties OPERATIONS: Plans, organizes...3 years previous leadership experience required Licenses and Certifications RN - Registered Nurse Current… more
    Texas Health Resources (10/16/25)
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  • Clinical Registered Nurse

    Cognizant (Carson City, NV)
    …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
    Cognizant (10/07/25)
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  • Case Manager ( RN ) - Utilization

    Prime Healthcare (San Dimas, CA)
    …experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/229285/case-manager-%28rn%29 utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySan… more
    Prime Healthcare (10/10/25)
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  • Utilization Management Nurse

    CVS Health (Phoenix, AZ)
    …a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and ... Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care … more
    CVS Health (10/01/25)
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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 - Evaluate medical necessity for procedures and care requests - Use internal Access… more
    Insight Global (10/16/25)
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