• Utilization Management Coordinator

    Saint Francis Health System (Tulsa, OK)
    …in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal ... completed the basic professional curricula of a school of nursing as approved and verified by a state board...and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker (LCSW), or Professional… more
    Saint Francis Health System (10/08/25)
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  • Utilization Review Specialist

    CaroMont Health (Gastonia, NC)
    …fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments, Care ... to practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management , Quality and/or Case Management preferred.… more
    CaroMont Health (10/11/25)
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  • Utilization Review Nurse

    US Tech Solutions (Chicago, IL)
    …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION ... 3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior...in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST… more
    US Tech Solutions (10/17/25)
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  • RN - Utilization Management - Full…

    Sanford Health (Fargo, ND)
    …various other nursing interventions. Functions within the scope and standards of nursing practice as outlined in the Nurse Practice Act and Administrative ... ** **Job Summary** Provides expertise and leadership to ensure effective resource management for patient care delivery across the care continuum for assigned patient… more
    Sanford Health (09/24/25)
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  • Utilization Review Specialist

    BriteLife Recovery (Englewood, NJ)
    …compliance. + Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials, approvals, ... assigned What we need from you? + Minimum of 2-3 years of experience in utilization review, case management , or insurance coordination in a behavioral health or… more
    BriteLife Recovery (10/04/25)
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  • Utilization Review Nurse

    US Tech Solutions (May, OK)
    …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1 YEAR OF UTILIZATION ... . 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior...in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT… more
    US Tech Solutions (10/17/25)
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  • Utilization Review Registered Nurse

    Centene Corporation (New York, NY)
    …and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a ... million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization...as a State Issued NY ID.** **Position Purpose:** The Utilization Review Nurse I provides first level… more
    Centene Corporation (10/15/25)
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  • LVN Case Manager - Utilization Mgmt…

    Sharp HealthCare (San Diego, CA)
    …time for routine, urgent and expedited referrals as outlined in SCMG's Utilization Management Plan.Decisions will be communicated to the appropriate persons ... + Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, established criteria such as… more
    Sharp HealthCare (10/23/25)
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  • Utilization Review Nurse

    CDPHP (Latham, NY)
    …required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is ... you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for...transportation, DME requests and inpatient readmissions. In collaboration with management , the UR nurse identifies potentially high-cost… more
    CDPHP (09/23/25)
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  • Utilization Review Clinician - Behavioral…

    Centene Corporation (Atlanta, GA)
    …hours.** **The ideal candidate will have experience in behavioral health utilization management .** **Education/Experience:** Requires Graduate of an Accredited ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
    Centene Corporation (10/10/25)
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