• Supervisor Utilization Review

    Martin's Point Health Care (Portland, ME)
    …preferred + 3 years of medical management experience in a managed care setting including utilization review + RN experience in a clinical setting required + ... 2015. Position Summary The Supervisor is responsible for day-to-day operations of the utilization review team, which includes clinical and non-clinical staff, in… more
    Martin's Point Health Care (10/01/25)
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  • RN Utilization Review

    HonorHealth (AZ)
    …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... Nurse in an acute care setting - Required Licenses and Certifications + Registered Nurse ( RN ) State And/Or Compact State Licensure - Required +… more
    HonorHealth (09/26/25)
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  • Clinical Resource Coordinator…

    Penn Medicine (Philadelphia, PA)
    …rewarding and ** REMOTE RN ** role! This role will focus primarily on utilization review which is why **we are seeking individuals who have between 3 to ... assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet) Credentials: + Registered Nurse - PA (Required) + PA RN Licensure required. Education or… more
    Penn Medicine (10/02/25)
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  • Utilization Review Nurse

    Martin's Point Health Care (Portland, ME)
    …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use...and offerings. Education/Experience: + Unrestricted state license as a Registered Nurse required; BSN preferred. + 3+… more
    Martin's Point Health Care (09/25/25)
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  • * RN Coordinator- Utilization

    Henry Ford Health System (Warren, MI)
    …screening criteria and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical ... Management experience in lieu of bachelor's degree. CERTIFICATIONS/LICENSURES REQUIRED: + Registered Nurse with a valid, unrestricted State of Michigan License.… more
    Henry Ford Health System (09/25/25)
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  • Utilization Review Clinician

    Monte Nido (Miami, FL)
    …lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** ** Remote ** **Monte Nido has ... Remotely. **This is a Full-Time remote position working CST/MST hours.** The Utilization Review Clinician is responsible for conducting all utilization more
    Monte Nido (09/06/25)
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  • Behavioral Health Utilization Management…

    CVS Health (Frankfort, KY)
    …it all with heart, each and every day. **Position Summary** This is a fully ** remote ** Utilization Review Clinical Consultant. **Must reside in the state of ... Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse ( RN ) with active...schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Foster Care population… more
    CVS Health (09/13/25)
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  • Utilization Management Nurse

    CVS Health (Columbus, OH)
    …it all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr days ... other events, as directed by their Leader. **Required Qualifications** + Active and unrestricted Registered Nurse in state of residence + 3+ years of experience… more
    CVS Health (09/20/25)
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  • Utilization Management Nurse

    CVS Health (OH)
    …healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position Summary** The Team Lead plays ... 5+ years of clinical practice experience in medical healthcare. + 3+ years Medical Review or Utilization Management experience. + 2+ years of experience with… more
    CVS Health (09/24/25)
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  • Registered Nurse ( RN ) Case…

    Ochsner Health (New Orleans, LA)
    …case management or utilization review . **Certifications** Required - Current registered nurse license in state of practice. Basic Life Support (BLS) from ... and implement discharge plans based on patient's individualized needs. Registered Nurse ( RN ) Case Manager...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
    Ochsner Health (07/30/25)
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