• System Utilization Management SUM…

    Alameda Health System (Oakland, CA)
    System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Services As ... The System Utilization Management [SUM] Utilization Review RN is responsible...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
    Alameda Health System (05/06/25)
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  • Manager - Utilization Review

    Beth Israel Lahey Health (Plymouth, MA)
    …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Barnstable counties. Our Nutrition Services Team consists of registered and licensed dietitians who provide expert nutritional interventions...and Serve Your Community!** **In your role as a Utilization Review & Denials Management more
    Beth Israel Lahey Health (04/29/25)
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  • Utilization Management Review

    AmeriHealth Caritas (LA)
    …Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred. + An active Registered Nurse ( RN ) license in good standing is required. + 3+ ... Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services,… more
    AmeriHealth Caritas (06/25/25)
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  • Per Diem RN Case Manager,…

    Children's Hospital Boston (Boston, MA)
    80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management /ReviewDepartment:Patient Services-Patient Care ... Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current...preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse ( RN ) + A… more
    Children's Hospital Boston (06/16/25)
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  • Utilization Management Review

    AmeriHealth Caritas (Washington, DC)
    …health care, or medical office setting **Licensure** + Current driver's license required + A Registered Nurse ( RN ) license in the District of Columbia in ... Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services,… more
    AmeriHealth Caritas (06/03/25)
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  • Utilization Review Nurse

    US Tech Solutions (Chicago, IL)
    …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in...+ Do you have experience with Utilization Review ? + Do you have an Active Registered more
    US Tech Solutions (04/18/25)
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  • Pediatric Shift Care Utilization

    AmeriHealth Caritas (Philadelphia, PA)
    …preferred + Minimum of 3 years of experience providing direct patient care;as a Registered Nurse working with medically fragile pediatric patients in a clinical ... setting + Minimum of 3 years of Utilization Management experience, preferably within a managed...such as;InterQual, desired **Licensure** + Current, active, and unrestricted Registered Nurse licensure in Pennsylvania **Skills &… more
    AmeriHealth Caritas (05/22/25)
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  • Utilization Review Nurse

    US Tech Solutions (May, OK)
    …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... . 1+ years of inpatient hospital experience . Registered Nurse in state of residence ....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. . MUST HAVE… more
    US Tech Solutions (04/18/25)
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  • Manager, Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
    Commonwealth Care Alliance (05/21/25)
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  • RN - Utilization Review

    Baptist Memorial (Meridian, MS)
    RN with 3 years of clinical experience Preferred/Desired: RN with Case Management or Utilization Review experience in a hospital or payer setting ... Overview RN Utilization Review Weekender Job...Utilization Review Weekender Job Summary The Utilization Review Nurse is responsible for… more
    Baptist Memorial (04/22/25)
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