• Clinical Nurse Case Disease Management

    Blue KC (Workman, MN)
    …department, etc.). **Minimum Qualifications** + Associate degree in nursing + Valid and active Registered nurse ( RN ) in Missouri and Kansas. + 3 years ... transplant authorization, issues authorization letters, and follows in FACETS UM system in accord with UM concurrent...management and clinical transplant experience + Valid and active Registered nurse ( RN ) licensure in… more
    Blue KC (12/13/25)
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  • Utilization Management Specialist

    Cleveland Clinic (Cleveland, OH)
    …+ Graduate of an accredited School of Nursing + Current state licensure as a Registered Nurse ( RN ) + Basic Life Support (BLS) Certification through the ... basic disease processes + Three years of equivalent full-time clinical experience as a Registered Nurse + Analytical ability required to gather data, decide on… more
    Cleveland Clinic (10/18/25)
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  • Executive System Director of Utilization…

    UNC Health Care (Morrisville, NC)
    …serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a strategic and operational leader responsible for designing, implementing, ... systems (ISD) to create a unified and standardized utilization management ( UM ) infrastructure. This collaboration ensures the delivery of high-quality, value-based… more
    UNC Health Care (10/29/25)
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  • Utilization Management Coordinator

    Saint Francis Health System (Tulsa, OK)
    …field. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker (LCSW), or ... and their receipt of necessary services and appropriate discharge planning. UM Coordinators participate in treatment teams, communicating with providers the details… more
    Saint Francis Health System (11/14/25)
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  • Supervisor Home Modification Specialist

    AmeriHealth Caritas (Philadelphia, PA)
    …; **Education/ Experience:;** + Bachelor's degree or equivalent relevant experience + Unrestricted Registered Nurse ( RN ) or Physical Therapist (PT) + Valid ... the day-to-day operations of the LTSS Review Home Modification and LTSS UM Department, including authorization and approval of services, appeals and the coordination… more
    AmeriHealth Caritas (11/13/25)
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  • Home Health Admissions Nurse McKnight

    UPMC (Seven Fields, PA)
    UPMC Home Health is Hiring a Full-Time Admissions Registered Nurse ( RN ) in the McKnight, Allison Park, Etna, Glenshaw and surrounding areas! UPMC Home Health ... + Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR) + Driver's License + Registered Nurse ( RN ) OR Temporary Practice Permit (TPP) + Act… more
    UPMC (12/12/25)
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  • Utilization Management Nurse Consultant…

    CVS Health (Austin, TX)
    …in clinical setting with diverse cultural dynamics of clinical staff and patients. Registered Nurse ( RN ) required. Licensed Clinical Social Worker (LCSW) ... and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): +… more
    CVS Health (12/14/25)
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  • Care Review Clinician - NM resident - Licensed LPN…

    Molina Healthcare (NM)
    …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational Nurse (LVN) ... medical clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ), Licensed Vocational Nurse more
    Molina Healthcare (10/30/25)
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  • Home Health Professional Staff Nurse - Cole

    UPMC (Coudersport, PA)
    …+ Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR) + Driver's License + Registered Nurse ( RN ) OR Temporary Practice Permit (TPP) + Act ... UPMC Home Health is hiring a Registered Nurse for the area. Are...with rotations for on-call and weekend coverage. As an RN with UPMC Home Healthcare, you'll collaborate with our… more
    UPMC (12/12/25)
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  • Supervisor, Utilization Management

    Centene Corporation (Sacramento, CA)
    …management principles preferred. 25% Travel CA RN License Required **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency… more
    Centene Corporation (12/11/25)
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