utilization management rn

Mercy is seeking a Utilization Management RN to support appropriate, cost-effective patient care across our Midwest network. The RN will review medical necessity, treatment plans, and level of care using established clinical criteria, collaborating with physicians, care managers, and payers. Responsibilities include chart review, authorization management,...

Mercy is seeking a Utilization Management RN to support appropriate, cost-effective patient care across our Midwest network. The RN will review medical necessity, treatment plans, and level of care using established clinical criteria, collaborating with physicians, care managers, and payers. Responsibilities include chart review, authorization management,...

Guidehealth is seeking an Utilization Management Registered Nurse to perform medical-necessity reviews and document findings for determinations. The role involves collaborating with medical leadership, reviewing cases for appropriate treatments, and ensuring timely decisions in a remote work environment. Ideal candidates hold an active IL RN license, have...

Job Description\n American Traveler is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Somerville, Massachusetts.Job Description & Requirements\n \n Specialty: Utilization Review\n Discipline: RN\n Start Date: 10/15/2026\n Duration: 11 weeks\n 40 hours per week\n Shift: 8 hours, days\n Employment Type: Travel\n \n...

JOB DESCRIPTION Job Summary Work Location: California - Ability to work remote, but selected candidate must reside in the state of California. This position requires California RN Licensure. Candidates must have significant IPA delegation experience. Leads and directs a multidisciplinary team of healthcare services professionals in some or all of...

Wound Care Utilization Management RN Location This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note...

JOB DESCRIPTION Job SummaryWork Location:California - Ability to work remote, but selected candidate must reside in the state of California. This position requires California RN Licensure. Candidates must have significant IPA delegation experience. Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following...

Wound Care Utilization Management RNLocation: This role enables associates to work virtually full-time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development. Please...

JOB DESCRIPTION Job Summary Work Location: California - Ability to work remote, but selected candidate must reside in the state of California. This position requires California RN Licensure. Candidates must have significant IPA delegation experience. Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the...

Find your calling at Mercy! Overview Utilization Management for the assigned inpatient Care Management population. This position is designed to facilitate an effective process of the Mercy Care Management model; supporting quality patient care, safety and financial components; promoting integration of a seamless care model; assisting with patient...

Job Description Find your calling at Mercy!/n Overview/n /nUtilization Management for the assigned inpatient Care Management population. This position is designed to facilitate an effective process of the Mercy Care Management model; supporting quality patient care, safety and financial components; promoting integration of a seamless care model; assisting...

Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards Collaborates with...

Elevance Health is seeking a Wound Care Utilization Management RN to work primarily virtually with periodic in-person training sessions. The role requires an active RN license, WOCN or CWS certification, and at least 3 years in diverse health care settings.The RN will coordinate care plans, review home-based services, and discuss plans of care with...

Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards Collaborates with...

PA RN License RequiredWe are seeking an experienced Care Management Coordinator to join our Infusion Therapy team. This role is responsible for performing utilization management reviews to determine the medical necessity of requested healthcare services, ensuring members receive appropriate, evidence-based care while maintaining compliance with regulatory...

Overview ERP International is seeking a Clinical Nurse (RN), Utilization Manager for a Full-Time position in supportof the 42 Medical Group at Maxwell AFB, AL. Be the Best! Join our team of exceptional health care professionals across the nation. Come discover the immense pride and job satisfaction ERP Employees experience in providing care for our Military...

RemoteRemote - USAFull timeR2659959If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered.Day - 08 Hour (United States of America)This is not a CRONA-union position.Shift Length: Employees will work shifts that range from 8 to 10...

American Traveler is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Somerville, Massachusetts. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 10/15/2026 Duration: 11 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Assignment Overview Shift: Days,...

American Traveler is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Somerville, Massachusetts. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 10/15/2026 Duration: 11 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Assignment Overview Shift: Days,...

Solomon Page is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Fort Myers, Florida.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNStart Date: 10/26/2026Duration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelOur client is looking to add a Registered Nurse to their...