- University Health (Hondo, TX)
- …years of clinical nursing experience is required. Data entry, referral management , utilization management experience is required. Case Management ... outcomes, compliance, and decrease complications. EDUCATION/EXPERIENCE Graduation from an accredited school of nursing , RN or LVN is required. A minimum three… more
- University Health (Pleasanton, TX)
- …(as a Staff nurse II or above). Work experience in case management , utilization review or hospital quality is preferred. LICENSURE/ CERTIFICATIONS Current ... and communicate health care needs. EDUCATION/EXPERIENCE Bachelor's degree in Nursing is highly preferred. Three to five years ... Nurse with the Texas State Board of Nurse Examiners is required. An approved case management… more
- University Health (Boerne, TX)
- …years recent, full time hospital experience preferred. Work experience in case management , utilization review, or hospital quality assurance experience is ... and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to… more
- University Health (Pleasanton, TX)
- …Three years recent, full-time hospital experience preferred. Work experience in case management , utilization review or hospital quality assurance experience is ... skills for serving in the liaison roles with medical staff, nursing , and patients and families. EDUCATION/EXPERIENCE Graduation from an accredited school… more
- Mercy (Dexter, MO)
- …practice for Registered Nurse . Experience: Minimum three years nursing experience. Previous leadership/ management experience preferred. Certifications: BLS, ... Find your calling at Mercy! Responsible for assisting the Chief Nursing Officer in the delivery of safe, quality and cost efficient care by having competent staff… more
- Whidbey General Hospital (Coupeville, WA)
- Director Surgical Services POSITION SUMMARY The Director of Surgical Services is the nursing leader for the perioperative service area of the hospital and reports ... directly to the Chief Nursing Officer. The ideal candidate will possess the ability...culture and provide caring and decisive leadership to their management team. Responsibilities include developing departmental policies and procedures… more
- Centene Corporation (Sacramento, CA)
- …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 utilization management team to resolve complex care member issues +… more
- UNC Health Care (Morrisville, NC)
- …the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible ... for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a complex academic health system and… more
- Katmai (Fort Carson, CO)
- …American Red Cross. + Three (3) years within the last four (4) years as a registered nurse in utilization management . + One (1) year of experience in UR/UM ... Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE...provisions within the catchment areas that affect the financial utilization of the Government by using professional nursing… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- Summary The Patient Flow - Utilization Management Coordinator Registered Nurse (RN) considers all characteristics of the individual, in order to assist each ... to: The primary purpose of the Patient Flow - Utilization Management Coordinator RN position is to...requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse… more
- Alameda Health System (Oakland, CA)
- … Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + Posted:March ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...in Nursing Preferred Education: Master's degree in Nursing Required Experience: Three years of utilization … more
- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Nov 30, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career ... care and their communities. Role Overview: The role of Utilization Management Manager oversees the integration of...for this role will have a bachelor's degree in nursing , public administration, public policy, public health or related… more
- McLaren Health Care (Port Huron, MI)
- …to be obtained within five years of accepting position. ⦁ Three years of recent nursing or utilization management experience with an acute care hospital ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer Success Organization who will provide clinical ... best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as...acute care setting + 2+ years of experience in utilization management + Knowledge and understanding of… more
- CVS Health (Columbus, OH)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... on the telephone, and type on the computer. **Preferred Qualifications** Utilization Management experience preferred **Education** Diploma RN acceptable;… more
- CVS Health (Salem, OR)
- …we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical skills to ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA… more
- Trinity Health (Columbus, OH)
- …years of clinical nursing experience with at least 2 years' experience in utilization review or case management . Nursing experience in an HMO insurance ... technology, financial analysis, audit, provider relations and more. **Position Purpose** RN Utilization Management MCHP is responsible for the coordination of… more
- CVS Health (Austin, TX)
- …to work Monday through Friday, 10am to 7pm EST with occasional holiday rotation. Utilization Management is a 24/7 operation and work schedules will include ... Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN...10:00am to 7:00pm eastern time with occasional holiday rotation. Utilization Management is a 24/7 operation and… more
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