• Utilization Management Nurse

    Humana (Madison, WI)
    …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
    Humana (09/12/25)
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  • Utilization Management Nurse

    Humana (Madison, WI)
    **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
    Humana (11/16/25)
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  • Utilization Management Nurse

    Humana (Madison, WI)
    **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...at a time that is best for your schedule. **Work-At- Home / Internet Information:** To ensure Home more
    Humana (11/18/25)
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  • SNF Utilization Management RN…

    Humana (Madison, WI)
    **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
    Humana (09/12/25)
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  • Disease Management Nurse - Remote

    Sharecare (Madison, WI)
    …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...minimum. + This position will be based in a home office which must satisfy all HIPAA requirements. Sharecare… more
    Sharecare (10/22/25)
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  • Case Manager, Registered Nurse - Fully…

    CVS Health (Madison, WI)
    …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse more
    CVS Health (11/19/25)
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  • Registered Nurse (RN) - Community Living…

    Veterans Affairs, Veterans Health Administration (Milwaukee, WI)
    Summary The function of the Community Living Center (CLC) Registered Nurse (RN) is to provide, direct, and supervise the delivery of quality nursing care to veterans ... medical issues. Responsibilities The Community Living Center (CLC) Registered Nurse (RN) is responsible and accountable for all elements...the Veterans with optimal care. This is the Veterans home and the care delivered is resident centered and… more
    Veterans Affairs, Veterans Health Administration (11/19/25)
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  • RN UM Clinical Appeals Nurse Remote

    Molina Healthcare (Green Bay, WI)
    …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical...be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and… more
    Molina Healthcare (11/14/25)
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  • LVN Delegation Oversight Nurse Remote

    Molina Healthcare (Madison, WI)
    …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... must be technologically proficient, self-directed, autonomous and experience working from home . Care Management & Waiver Service Auditing experience is… more
    Molina Healthcare (11/13/25)
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  • Clinical Reviewer, Nurse

    Evolent (Madison, WI)
    …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... is 11:30-8:00 eastern** **OTHER SKILLS and ABILITIES:** Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic… more
    Evolent (11/20/25)
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