- Blue KC (MO)
- …and regularly attends client meetings (with benefits managers and executives) to review health outcomes and cost information. + Actively monitors care management ... special consideration (eg, benefits) should be made. + Participate in existing client utilization and renewal meetings or tell our clinical value story as requested.… more
- Humana (Lincoln, NE)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- Saint Francis Health System (OK)
- …their placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers ... reimbursement issues and participate in treatment teams, Patient Care Committee, and the Utilization Review Staff Committee by providing data and contributing to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
- Centene Corporation (Honolulu, HI)
- …a fresh perspective on workplace flexibility. Remote Position. Must Reside in Hawaii Registered Nurse ( RN ) or Licensed Clinician Only. Must have a ... abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with...+ Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse -… more
- Children's Mercy Kansas City (Kansas City, MO)
- …+ Experience in Utilization Review + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + ... training oversight of programs and services. Responsible for effective utilization review and proper resource management of...One of the following: Licensed RN - Kansas, Registered Nurse … more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective,… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Cottingham & Butler/...Practitioner - Dubuque, IA - 26 ann MercyOne CVU RN - Cardiovascular Registered Nurse ... 4627707008 Posted On 07/01/2025 Refreshed On 11/23/2025 **Job Overview** ** Utilization Management Nurse ** **Location** : Onsite in...MercyOne Acute Care RN - Medical Unit Registered Nurse MercyOne Acute Care RN… more
- Molina Healthcare (Spokane, WA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job Summary The Care Review Clinician ( RN ) provides support for...critical care experience, ie ER or ICU. Candidates with Utilization Management and med/surge experience are highly preferred. Exceptional… more
- Molina Healthcare (Austin, TX)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support...member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm… more