• Clinical UM Nurse 2

    CenterWell (Boston, MA)
    …of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent ... your skills to make an impact** **Required Qualifications** + Licensed Registered Compact Nurse license (RN) with no disciplinary action and ability to obtain non… more
    CenterWell (09/26/25)
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  • RN UM Care Review Clinician, Inpatient…

    Molina Healthcare (Boston, MA)
    …Job Summary The Care Review Clinician, IP 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...a candidate with a MA RN licensure. Candidates with UM Medical Review background and experience using MCG or… more
    Molina Healthcare (10/01/25)
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  • Per Diem Clinical Appeal Nurse

    Fallon Health (Worcester, MA)
    …of clinical criteria and medical necessity determinations. The Appeal Nurse is responsible for ensuring compliance with all applicable state and federal ... the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge,… more
    Fallon Health (09/22/25)
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  • Registered Nurse (RN) Utilization…

    Commonwealth Care Alliance (Boston, MA)
    …Reporting to the Manager Utilization Management, the Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day timely clinical and service ... with Standard Operating Procedures + Ensures accurate documentation of clinical decisions and works with UM Manager...Utilization Management experience in a managed care setting + 2 or more years working in a clinical… more
    Commonwealth Care Alliance (10/02/25)
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  • RN, Manager, Utilization Management Nursing

    Humana (Boston, MA)
    …for providing leadership and oversight of the physical health utilization management ( UM ) staff in daily operations. + Uses clinical knowledge, communication ... Manager, Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical nursing skills to support the coordination, documentation and… more
    Humana (09/28/25)
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