- Actalent (Atlanta, GA)
- Job Title: Utilization Review - FULLY REMOTE...- Appeals, and Risk Management. Essential Skills + Registered Nurse (RN) with a valid license in GA or ... + Experience with MCG or Interqual is preferred. + Utilization review experience is a plus. Work...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Cottingham & Butler/ SISCO** 1 Positions ID: 4627707008 Posted On 07/01/2025 Refreshed On 11/23/2025 **Job Overview** ** ... Utilization Management Nurse ** **Location** : Onsite in Dubuque, IA. Also accepting remote applicants. We are looking for a nurse just like you - a … more
- CVS Health (Harrisburg, PA)
- …all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical experience in acute...and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with… more
- CVS Health (Columbus, OH)
- …Microsoft Office Applications (Outlook, Teams, Excel) **Preferred Qualifications** - Utilization review experience preferred - Knowledge of Medicare/Medicaid ... operation and work schedule may include weekends, holidays, and evening hours._ **UM Nurse Consultant** Fully Remote - WFH **Schedule** - Mon-Fri 10:30AM-7PM with… more
- Henry Ford Health System (Warren, MI)
- …Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical experience required. +… more
- CVS Health (Albany, NY)
- …all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state ... 8:30am - 5pm EST. This role is a registered nurse that utilizes MCG rules and applies medical necessity...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of… more
- CenterWell (San Juan, PR)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CenterWell (Austin, TX)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
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