• 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

    Crouse Hospital (Syracuse, NY)
    …and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse ( RN ) to track and manage data ... 8:00am-4:30pm, requires 6 weekends a year. Utilization Management Registered Nurse ( RN...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… more
    Crouse Hospital (09/25/25)
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  • Registered Nurse ( RN

    Commonwealth Care Alliance (Boston, MA)
    …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
    Commonwealth Care Alliance (10/02/25)
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  • Utilization Management Appeals…

    CVS Health (Columbus, OH)
    … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position ... by reviewing medical records and applying clinical guidelines for Utilization Management group. This RN ...permitted. **Required Qualifications** + 3+ years Utilization Management or Utilization Review experience.… more
    CVS Health (10/12/25)
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  • Utilization Management Admissions…

    LA Care Health Plan (Los Angeles, CA)
    Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
    LA Care Health Plan (10/03/25)
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  • RN , Manager, Utilization

    Humana (Lansing, MI)
    …areas. **Use your skills to make an impact** **Required Qualifications** + An active, unrestricted Registered Nurse ( RN ) license in the state of Michigan. + ... Previous experience in utilization management and/or utilization review . + Minimum of two (2) years of proven experience in management or leadership… more
    Humana (10/15/25)
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  • RN Utilization Management

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating ... benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer...+ Licensure in additional states a plus. + For registered nurses only: a bachelor's degree in (BSN) preferred.… more
    Blue Cross Blue Shield of Massachusetts (10/22/25)
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  • Utilization Management Manager…

    CareFirst (Baltimore, MD)
    …+ Proficient in Microsoft Office programs. **Licenses/Certifications Required Upon Hire** : Health Services\ RN - Registered Nurse - State Licensure and/or ... week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages… more
    CareFirst (10/11/25)
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  • Manager, Healthcare Services; Utilization

    Molina Healthcare (GA)
    …experience. * At least 1 year of health care management /leadership experience. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), Licensed ... or more of the following activities: care review , care management , utilization management (prior authorizations, inpatient/outpatient medical necessity,… more
    Molina Healthcare (09/19/25)
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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...skills to make an impact** **Required Qualifications** + **​Licensed Registered Nurse ( RN )** in the… more
    Humana (09/12/25)
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