- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or Care … more
- Hackensack Meridian Health (Neptune City, NJ)
- …to transform healthcare and serve as a leader of positive change. The Care Management , ** Care Coordinator, Utilization Management ** is a member of ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans...Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health Care … more
- Alameda Health System (Oakland, CA)
- …#:42522-31559 + FTE:1 + Posted:July 18, 2025 **Summary** **SUMMARY:** The System Utilization Management (SUM) Care Without Delay RN is a pivotal role ... + Highland General Hospital + SYS Utilization Management + Full Time - Day + Care...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
- Central Maine Medical Center (Lewiston, ME)
- …experiences for our community and for each other every day. Position Summary: The Utilization Management Nurse is responsible for a comprehensive clinical ... minimum qualifications for the position including:*Current State of Maine RN licensure.*Three (3) or more years of previous experience...licensure.*Three (3) or more years of previous experience in Utilization Management and/or Care … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Bring your true colors to blue. The Role The RN Utilization Management Reviewer is responsible for facilitating care for members who may have complex ... the best quality care . The Team The RN Utilization Management Reviewer is...against a license must be disclosed and reviewed + Registered nurses only, bachelor's degree in nursing (BSN) preferred… more
- CVS Health (Tallahassee, FL)
- …anywhere in the state of Florida. **Applicant must reside in Florida** . As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... setting required - Must have active current and unrestricted RN licensure in state of Florida - Willingness to...- Must reside in Florida **Preferred Qualifications** - Previous Utilization Management and/or Managed Care … more
- McLaren Health Care (Indianapolis, IN)
- We are looking for a Utilization Management RN , to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned ... + Two(2)yearsclinicalnursingexperience. + One (1) year previous experience in Managed Care Utilization Management , Medical Management , Case Management… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is...player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Catholic Health Services (Melville, NY)
- …development to remain current with industry standards and business objectives related to Utilization and Care Management as appropriate. Sound knowledge and ... for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the...as applicable to position needs. Experienced appeals writer and Care Management experience required in an acute… more
- Guthrie (Binghamton, NY)
- Provides health care services regarding admissions, case management , discharge planning and utilization review. Responsibilites: Reviews admissions and ... coordinates compliance to federally mandated and third party payer utilization management rules and regulations The pay...a part of a tradition of excellence in health care . In all areas and at all levels of… more
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