utilization management-rn

Utilization Management RNWe’re actively seeking qualified candidates for a Utilization Management Coordinator / RN opportunity supporting inpatient utilization management and care coordination. This position is remote; however, candidates must reside in Pennsylvania, New Jersey, or Delaware to be eligible for potential conversion.Position OverviewThe...

The Utilization Management (UM) Nurse is responsible for conducting clinical reviews and assessing the medical necessity, appropriateness, and efficiency of healthcare services requested by providers and members. This role supports the health plan’s utilization management functions in alignment with clinical guidelines, plan benefits, regulatory...

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,...

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...

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...

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...

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...

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 the...

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...

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...

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...

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...

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...

AMN Healthcare Revenue Cycle is seeking a travel RN Remote Case Manager, Utilization Review for a Minneapolis assignment. The role oversees UR team leadership, medical necessity review, and collaboration with clinicians and payers to ensure proper patient status and care level.The position requires a BSN, Minnesota RN licensure, and UR experience, with 40...