• Utilization Management…

    Humana (Richmond, VA)
    **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… more
    Humana (01/18/26)
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  • Appeals Nurse

    Evolent (Richmond, VA)
    …and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to ... and as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals , compliance and/or grievances/complaints in a quality… more
    Evolent (12/24/25)
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  • Revenue Integrity Nurse Auditor

    Childrens Hospital of The King's Daughters (Chesapeake, VA)
    …as a Certified Professional Coder required. + Three to five years of case management utilization review, or compliance related work experience in a hospital ... + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and...supporting documentation, as well as facilitates the completion of appeals in a timely manner. + Prepares trend and… more
    Childrens Hospital of The King's Daughters (10/23/25)
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  • Infusion Referral Nurse Sr- REMOTE

    Prime Therapeutics (Richmond, VA)
    …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing criteria. + At ... the future of pharmacy with us. **Job Posting Title** Infusion Referral Nurse Sr- REMOTE **Job Description** Under supervision, is responsible for performing… more
    Prime Therapeutics (01/16/26)
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