Nursing Jobs

Rxadvance CorporationNew

Utilization Management Nurse- Part-Time - REMOTE

$38 - $40/hr

Posted 1 day ago

Join us in our mission to transform healthcare! nirvanaHealth (under RxAdvance Corp.) is committed to bringing the art of the possible to the payer and PBM industries. We invest in our employees at every stage of life. Success radiates across all levels of our organization, driven by competitive benef...

Presidential Staffing Solutions, LLCNew

Utilization Management Nurse

$41 - $45/hr

Posted 1 day ago

401(k) Employee discounts Paid time off Competitive salary Dental insurance Health insurance Vision insurance Benefits/Perks Competitive Compensation Great Work Environment Career Advancement Opportunities Job Summary We are seeking a Utilization Management Nurse to join our team! As a Utilization Management...

Brighton Health Plan Solutions, LLCNew

Utilization Management Nurse

Compensation not listed

Posted 1 day ago

BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely. Primary Responsibilities Perform...

Devoted HealthNew

Clinical Guide: (UM) Utilization Management Nurse (Outpatient Prior Authorization)

$82,680 - $96,460/yr

Posted 1 day ago

A bit about this role: As a Clinical Guide on our Outpatient Utilization Management team, you’ll have the opportunity to make a difference in the lives of our members. You’ll be responsible for clinical review of outpatient authorization requests — applying evidence-based medical necessity criteria, CMS...

Health First Careers

Utilization Management Nurse - Case Management

Compensation not listed

Posted 2 days ago

Job Requirements POSITION SUMMARY The Utilization Management (UM) Nurse performs medical necessity reviews on all payer admissions to determine appropriate admission status and documents all information that relates to insurance reimbursement in appropriate reviews for the Health First Integrated Delivery Network...

Humana

Utilization Management Nurse

$71,100 - $97,800/yr

Posted 3 days ago

Become a part of our caring community Are you passionate about helping individuals access the services and support they need to live safely and independently in their communities? As a Utilization Management (UM) Nurse, you will play a vital role in improving the health and well-being of Illinois Medicaid members by...

Integra Partners

Utilization Management Nurse - LPN/LVN

$60,000 - $60,001/yr

Posted 3 days ago

Integra is looking for a LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key role in collaborating with our Medical Director to perform benefit and medical necessity reviews and appeals within an...

Humana

Utilization Management Nurse

$71,100 - $97,800/yr

Posted 3 days ago

Become a part of our caring community The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require...

L.A. Care Health Plan

Utilization Management Nurse Specialist RN II

$88,854 - $142,166/yr

Posted 16 days ago

$88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Servin...

UnitedHealth Group

Inpatient Utilization Management Nurse, RN - Remote in PST or MST

$29 - $52/hr

Posted 20 days ago

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a...

L.A. Care Health Plan

Utilization Management Nurse Specialist RN II (Outpatient)

$88,854 - $142,166/yr

Posted 29 days ago

$88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Servin...

Children’s Hospital of Philadelphia

Utilization Management Nurse

$92,100 - $117,400/yr

Posted 1 month ago

Day (United States of America) Seeking Breakthrough Makers Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation. At CHOP, your experience is valu...

Children's Hospital of Philadelphia

Utilization Management Nurse

$92,100 - $117,400/yr

Posted 1 month ago

Day (United States of America) Seeking Breakthrough Makers Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation. At CHOP, your experience is valu...

HealthOne Alliance

Utilization Management Nurse

Compensation not listed

Posted 1 month ago

MISSION Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors. VALUES HealthOne is guided by a cultural framework that embodies our values and drives our decisions. Our PURPOSE is to care for...

CVS Health

Utilization Management Nurse Consultant

$29 - $62/hr

Posted 6 months ago

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do....