• Clinical UM Nurse

    CenterWell (Richmond, VA)
    …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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  • Clinical Reviewer, Nurse…

    Evolent (Richmond, VA)
    …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 (Richmond, VA)
    …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 - Home…

    Humana (Richmond, VA)
    …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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  • Transplant Care Nurse (Remote)

    Highmark Health (Richmond, VA)
    …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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  • Utilization Management Representative I

    Elevance Health (Norfolk, VA)
    …outpatient precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the ... identification and data entry of referral requests into the UM system in accordance with the plan certificate. + Responds to telephone and written inquiries from… more
    Elevance Health (01/14/26)
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