• RN - UM / Medical…

    Elevance Health (Las Vegas, NV)
    RN - Utilization / Medical Management Nurse / InPatient (JR171072) **Work Hours** : 8 hour shift within 8am - 6pm PST. Rotating Weekends and holidays. ... 8am - 6pm PST. Rotating Weekends and holidays. The ** Medical Management Nurse ** is responsible...an equivalent background. + Current active, valid and **unrestricted RN license** to practice as a health professional within… more
    Elevance Health (10/22/25)
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  • UM Case Manager

    Healthfirst (NV)
    …Services (CMS) or New York State Department of Health (NYSDOH) regulations governing medical management in managed care** + **Relevant clinical work experience** ... team in order to maximize HF member care quality while achieving effective medical cost management ** + **Assists in identifying opportunities for and… more
    Healthfirst (10/23/25)
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  • Inpatient Auth Review Services RN or LPN…

    HCA Healthcare (Las Vegas, NV)
    …Review, appeals, denials, managed care contracting, experienced preferred. + Currently licensed as a registered nurse ( RN ) in the state of Nevada and/ or ... application for the opportunity below: Inpatient Authorization Review Services- Registered Nurse or Licensed Practical Nurse...medical review request and /or denial activities to management as needed. **What you will do in this… more
    HCA Healthcare (10/26/25)
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  • Utilization Management Nurse - Home…

    Humana (Carson City, NV)
    …of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require ... courses of action. As a Utilization Management RN working on the OneHome/Home Solutions UM ...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more
    Humana (09/12/25)
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  • Care Review Clinician, PA ( RN )

    Molina Healthcare (Las Vegas, NV)
    …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… more
    Molina Healthcare (10/18/25)
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  • Care Manager RN - (Remote)

    Highmark Health (Carson City, NV)
    … UM /CM/QA/Managed Care **LICENSES AND CERTIFICATIONS** **Required** + Current RN state licensure required. Additional specific state licensure(s) may be required ... **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services,… more
    Highmark Health (10/22/25)
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  • Care Review Clinician RN (BH Licensed)…

    Molina Healthcare (Reno, NV)
    …with multidisciplinary teams to promote Molina care model. * Adheres to utilization management ( UM ) policies and procedures. * May work collaboratively with ... collaborate and coordinate with behavioral health medical directors, and senior medical directors to ensure proper management of the BHT benefit. Required… more
    Molina Healthcare (10/18/25)
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  • Utilization Management Nurse…

    CVS Health (Carson City, NV)
    … Management ( UM ) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... includes reviewing written clinical records. **Key Responsibilities of the UM Nurse Consultant** (Includes but is not...of Healthcare Services and benefit utilization. **Required Qualifications** + Registered Nurse ( RN ) with current… more
    CVS Health (10/25/25)
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  • Clinical Reviewer, Nurse -9am -6pm PST

    Evolent (Carson City, NV)
    …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... precertification and prior approvals. Tasks are performed within the RN /LVN/LPN scope of practice, under Medical Director...care + Minimum of one year of experience with medical management activities in a managed care… more
    Evolent (10/21/25)
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  • Telephonic Nurse Case Manager

    Humana (Carson City, NV)
    …**Required Qualifications** + Bachelor's degree in Nurse (BSN). + Valid and unrestricted Registered Nurse ( RN ) license in the (appropriate state) with no ... achieve desired clinical outcomes and to enhance quality of medical care. The **Telephonic Nurse Case Manager**...behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN) as needed, in… more
    Humana (10/23/25)
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