- University Health (Hondo, TX)
- …minimum three years of clinical nursing experience is required. Data entry, referral management , utilization management experience is required. Case ... with OB patients preferred. Experience working with EPIC EMR desirable. LICENSURE/CERTIFICATION Current licensure in the State of Texas as an RN or LVN is required. more
- University Health (Boerne, TX)
- …of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager ... Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred....full time hospital experience preferred. Work experience in case management , utilization review, or hospital quality assurance… more
- University Health (Pleasanton, TX)
- …of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is preferred. Case Manager ... Three years recent, full-time hospital experience preferred. Work experience in case management , utilization review or hospital quality assurance experience is… 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 ... licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC)… more
- Mercy (Dexter, MO)
- …BSN preferred. Licensure: Current license in applicable State of practice for Registered Nurse . Experience: Minimum three years nursing experience. Previous ... staff members in the Med Surg and Outpatient Departments. Insures efficient utilization of available resources and meets productivity and/or financial goals. Meets… more
- Whidbey General Hospital (Coupeville, WA)
- …care culture and provide caring and decisive leadership to their management team. Responsibilities include developing departmental policies and procedures consistent ... policies. The Director will also be responsible and accountable for overall management , planning, coordinating and directing of the Surgery and Post Anesthesia Care… more
- Katmai (Fort Carson, CO)
- …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 and ... Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE...full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… 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 ... to: The primary purpose of the Patient Flow - Utilization Management Coordinator RN position...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Centene Corporation (Sacramento, CA)
- …degree and 4+ years of related experience. Knowledge of utilization management principles preferred. Must have a CA RN License **License/Certification:** + ... ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks... RN - Registered Nurse - State Licensure and/or Compact State Licensure required… 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
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… 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...and clinical criteria evaluations.They will possess a current unrestricted RN license from the State of Indiana; a minimum… more
- McLaren Health Care (Port Huron, MI)
- …related duties as required and directed. **Qualifications:** Required ⦁ State licensure as a registered nurse ( RN ) ⦁ Bachelor's degree in nursing from ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… 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 ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in… 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 ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… 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
- Trinity Health (Columbus, OH)
- …information technology, financial analysis, audit, provider relations and more. **Position Purpose** RN Utilization Management MCHP is responsible for the ... Plan's UM Program and the review of the Plan's Utilization Management Plan. **What you will do**...Licensure / Certification: Current license to practice as a Registered Nurse in their home state or… more
- CVS Health (Columbus, OH)
- …and type on the computer. **Preferred Qualifications** Utilization Management experience preferred **Education** Diploma RN acceptable; Associate degree/BSN ... quality expectations as established by UMNC. **Required Qualifications** + Registered Nurse + 3+ years of experience...in acute or post-acute setting, and 1+ years of Utilization Management / Care Management … 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 ... hospital clinical practice. + Must have active and unrestricted RN ( _Registered Nurse_ ) Licensure in the state...Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in… more
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