• Clinical UM Nurse

    CenterWell (Phoenix, AZ)
    …our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...Lung or Critical Care Nursing experience required + Prior clinical experience preferably in an acute care, skilled or… more
    CenterWell (01/14/26)
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  • RN UM Care Review Clinician Remote

    Molina Healthcare (Scottsdale, AZ)
    …**Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services ... are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through… more
    Molina Healthcare (01/14/26)
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  • Clinical Reviewer, Nurse…

    Evolent (Phoenix, AZ)
    …coordinating with UM staff to ensure timely and accurate communication of clinical decisions. + Responsible for completion of UM projects and participation ... the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Vascular Surgey is responsible for support and… more
    Evolent (01/15/26)
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  • Clinical Reviewer, Nurse (Medical…

    Evolent (Phoenix, AZ)
    …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member...medical management activities in a managed care environment + UM /UR experience + Clinical experience in Oncology,… more
    Evolent (12/10/25)
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  • Utilization Management Nurse Consultant…

    CVS Health (AZ)
    …healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team. In this role, you'll ... be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to...+ Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM specialty teams… more
    CVS Health (01/16/26)
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  • Utilization Management Nurse - Home…

    Humana (Phoenix, AZ)
    …us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation… more
    Humana (01/13/26)
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  • Registered Nurse - Case Management

    ERP International (Luke AFB, AZ)
    …Current, full, active, and unrestricted license to practice as a Registered Nurse , any state. Clinical Certification:** Certified Case Manager by Commission ... **Overview** ERP International is seeking a full time **Registered Nurse - Case Management** in support of the56th Medical Group at Luke AFB, AZ… more
    ERP International (11/25/25)
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  • Transplant Care Nurse (Remote)

    Highmark Health (Phoenix, AZ)
    …experience, or provider operations and/or health insurance experience + 1 year in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year ... panel of members that range in health status/severity and clinical needs; and assesses health management needs of the...RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or… more
    Highmark Health (01/10/26)
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  • Care Review Clinician (RN)

    Molina Healthcare (Mesa, AZ)
    For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high ... review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that… more
    Molina Healthcare (12/24/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (Scottsdale, AZ)
    JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary ... and align with established clinical guidelines, insurance policies, and regulations - ensuring members...the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least… more
    Molina Healthcare (01/17/26)
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