Top 6269 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
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
- Nursing
Quick Apply
Remote Home Health RN – Medical Claims Reviewer
Broadway Ventures —Remote
- $60,000 - $63,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Customer service
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RN - Utilization Management - MGH
The General Hospital Corporation —Boston, MA
- $41.72 - $105.65 an hour
- Part-time
- Remote
- RN License
- Mid-level
- Experience equivalent to degree accepted
- Opportunities for advancement
Quick Apply
4d
Denials & Appeals Administrator (RN)
Boston Medical Center —Remote
- $43.03 - $62.50 an hour
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Health insurance
- Dental insurance
12d
Utilization Review RN
Providence —Mission Hills, CA
- $57.28 - $88.92 an hour
- Per diem
- Hybrid work
- Nursing
- RN License
- Medical office experience
- Paid parental leave
- Paid holidays
Nurse Educator (RN)
Wake Robin Corporation —Shelburne, VT
- $36.70 - $44.77 an hour
- Weekends as needed
- Nursing
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- Mid-level
- 403(b) matching
- Disability 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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- Disability insurance
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Director of Nursing
Northfield Retirement Community —Scottsbluff, NE
- Overnight shift
- Background check
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Patient Care Manager - Floater (RN)
VITAS Healthcare —Lombard, IL
- $0.70 per mile
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- Travel reimbursement
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RN Clinical Manager
Patients First Home Care LLC —Bradenton, FL
- $80,000 - $90,000 a year
- Full-time
- Background check
- CPR Certification
- Current TB test
- Continuing education credits
- Paid holidays
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RN Care Manager - Case Management - Shoreline Hospital
CHRISTUS Health —Corpus Christi, TX
- $27.50 - $46.00 an hour
- Full-time
- Acute care
- Background check
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Nursing Director of Women's Services
Navarro Regional —Corsicana, TX
- Full-time
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RN Unit Manager
Aloha Nursing Rehab Centre —Kaneohe, HI
- From $96,000 a year
- 8 hour shift
- Background check
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- Free parking
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TOP Case Management Program Manager
International SOS —San Antonio, TX
- Background check
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Summit County Skilled Health Home Registered Nurse
Hometown Care —Cuyahoga Falls, OH
- $40 - $100 an hour
- Temporary
- Hybrid work
- Background check
- Nursing
- RN License
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12d
Registered Nurse Traveler Cath Lab Multiple Shifts Available
HonorHealth —Phoenix, AZ
- Up to $2,943 a week
- Full-time
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- RN License
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RN Med Surg
Corewell Health —Grand Rapids, MI
- Full-time
- Acute care
- Nursing
- Surgery

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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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TOP Case Management Program Manager

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