- 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 ... Summary** The Appeals Nurse Consultant plays a key role in resolving clinical...3+ years Utilization Management or Utilization Review experience. + 3+ years clinical nursing… more
- 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 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The Manager, Utilization Management Nursing (LTSS Utilization Management Leader) ... communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA… more
- Access Dubuque (Dubuque, IA)
- Utilization Management CNA **Cottingham & Butler/...will also triage the call to determine if a Utilization Review Nurse is needed to complete ... Positions ID: 4823670008 Posted On 07/29/2025 Refreshed On 10/04/2025 **Job Overview** ** Utilization Management CNA** **Location** : Onsite in Dubuque, IA. Also… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... in standard medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care. + Knowledge of… more
- Molina Healthcare (GA)
- …services professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term ... or more of the following activities: care review, care management , utilization management (prior authorizations,...experience. * At least 1 year of health care management /leadership experience. * Registered Nurse (RN), Licensed… more
- Humana (Little Rock, AR)
- …help us put health first** Full-Time, Remote Telephonic opportunity 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...Time **Required Qualifications** + Minimum of Associate Degree in nursing + Licensed Registered Nurse (RN) in… more
- CVS Health (Baton Rouge, LA)
- …+ 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals experience in Utilization ... members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the… more
- CVS Health (Austin, TX)
- …6:00 pm EST or 9:30am to 6:00pm EST with occasional weekend/holiday/evening rotation.** ** Utilization Management is a 24/7 operation and work schedules will ... with heart, each and every day. Medicare Clinical Predetermination Nurse **Must be willing and able to work Monday...or 9:30am to 6:00pm eastern with occasional weekend/holiday/evening rotation. Utilization Management is a 24/7 operation and… more