Top 7991 Rn Utilization Management Jobs

Utilization Management Nurse I, RN
Clever Care Health Plan —Huntington Beach, CA
- $34.98 - $42.85 an hour
- Full-time
- Remote
- Background check
- Spanish
- RN License
Utilization Review RN
Houston Methodist Cypress Hospital —Cypress, TX
- Full-time
- Nursing
- RN License
- Hospital
RN Utilization Management
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Vision insurance
Concurrent Utilization Review Nurse, RN
NeueHealth —Los Angeles, CA
- $74,286.15 - $111,429.23 a year
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
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Remote Home Health RN – Medical Claims Reviewer
Broadway Ventures —Remote
- $60,000 - $63,000 a year
- Full-time
- Remote
- Nursing
- RN License
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Denials & Appeals Administrator (RN)
Boston Medical Center —Remote
- $43.03 - $62.50 an hour
- Full-time
- Remote
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- 5 years
- Health insurance
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12d
Utilization Management Registered Nurse
Humana —South Carolina
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
RN Director of Care Management - Sign-On Bonus Eligible
Merit Health River Region —Vicksburg, MS
- Full-time
- Nursing
- RN License
- Hospital
- Relocation assistance
- Health insurance
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Hospice Registered Nurse (RN)
Pioneer Valley Hospice and Palliative Care —Greenfield, MA
- Full-time
- CPR Certification
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- RN License
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Registered Nurse Traveler Cath Lab Multiple Shifts Available
HonorHealth —Phoenix, AZ
- Up to $2,943 a week
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
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RN - Assistant Nurse Manager (8a-5p) MedSurg/6200-6300 - Johnson City, TN
Ballad Health —Johnson City, TN
- Weekends as needed
- Nursing
- RN License
- PALS Certification
Clinical Reimbursement & Utilization Coord
St Camillus Residential Health —Syracuse, NY
- $24 - $30 an hour
- Full-time
- Mid-level
- Case management
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- Free parking
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3d
Director of Nursing
Northfield Retirement Community —Scottsbluff, NE
- Overnight shift
- Background check
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MDS Coordinator LPN/RN
Hallmark Healthcare of Carlinville —Carlinville, IL
- $35 - $50 an hour
- Online Application
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Charge RN – Med/Surg | Nights (Part-Time) | Sign-On
Lutheran Kosciusko Hospital —Warsaw, IN
- Part-time
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RN - Assistant Nurse Manager (3p-11p) W3 Oncology - Kingsport, TN
Ballad Health —Kingsport, TN
- Full-time
- Nursing
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Patient Care Manager - Floater (RN)
VITAS Healthcare —Lombard, IL
- $0.70 per mile
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RN Acute Case Manager - System Care Management - Full Time Day
The Guthrie Clinic —Sayre, PA
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RN Clinical Manager
Patients First Home Care LLC —Bradenton, FL
- $80,000 - $90,000 a year
- Full-time
- Background check
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Utilization Management Nurse I, RN

Clever Care Health Plan -
Huntington Beach, CA

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Job Details

Full-time
$34.98 - $42.85 an hour

Qualifications

RN License
Patient care

Full Job Description

Remote in California only

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.

Who Are We? ✨

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.

Why Join Us?

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.

Job Summary

The UM Nurse I - RN performs clinical review of authorization requests to determine medical necessity based on established criteria, regulatory requirements, and organizational policies. This role conducts utilization review activities under established guidelines and escalates complex or non-standard determinations to senior staff or the Medical Director.

Functions & Job Responsibilities

Conduct clinical review of prior authorization requests using approved criteria (e.g., MCG, InterQual).
Review outpatient and routine inpatient requests.
Ensure compliance with CMS, state, and contractual turnaround time requirements.
Document medical necessity determinations clearly and accurately.
Communicate authorization decisions to providers, members and internal teams.
Identify cases requiring physician or Medical Director review.
Participate in concurrent review and discharge planning coordination as assigned.
Ensure compliance with regulatory timelines.
Support audit readiness and documentation integrity.
Additional duties as assigned.

Qualifications

Education and Experience

Active, unrestricted RN license.
Minimum of three (3) years of clinical experience.
At least one (1) year in utilization management or case management preferred.

Skills

Knowledge of medical necessity criteria (MCG/InterQual).
Understanding of CMS/state UM regulations.
Strong clinical assessment and documentation skills
Ability to manage caseload efficiently.
Effective provider communication.
Bilingual proficiency in Cantonese, Mandarin, Spanish, Vietnamese, or Korean preferred.

Wage Range: $34.98 to $42.85 per hour

Physical & Working Environment.

Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:

Must be able to travel when needed or required
Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs. Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly. Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.

#LI-Remote

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RN - Assistant Nurse Manager (8a-5p) MedSurg/6200-6300 - Johnson City, TN

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Charge RN – Med/Surg | Nights (Part-Time) | Sign-On

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