Top 7062 Rn Utilization Management Jobs

UM Case Manager/Appeals Coordinator
Havenwyck Hospital (UHS) —Auburn Hills, MI
- $60,000 - $69,000 a year
- Full-time
- Background check
- LMFT
- Nursing
- Loan repayment program
- Health insurance
Quick Apply
Clinical Reimbursement & Utilization Coord
St Camillus Residential Health —Syracuse, NY
- $24 - $30 an hour
- Full-time
- Mid-level
- Case management
- LPN
- Free parking
- Dental insurance
Quick Apply
7d
Clinical Review and Appeals Specialist
Life Care Centers of America —Cleveland, TN
- Weekends as needed
- Nursing
- RN License
- Customer service
- Health insurance
- Dental insurance
Quick Apply
MDS Coordinator Part time
Brooklyn United Methodist Church Home —Brooklyn, NY
- $50 - $55 an hour
- Part-time
- Anatomy knowledge
- HIPAA
- Mid-level
- Free parking
- Paid time off
Quick Apply
Utilization Management- RN
South Country Health Alliance —Medford, MN
- $34.39 - $47.94 an hour
- Weekends as needed
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Disability insurance
- Health insurance
7d
Utilization Management Nurse Consultant
CVS Health —Florida
- $29.10 - $62.32 an hour
- Weekends as needed
- Remote
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
6d
Clinical Medical Review Nurse (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $67,320 - $133,705 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- 401(k)
Quick Apply
6d
Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
- Nursing
Quick Apply
Utilization Specialist
RiverWoods Behavioral Health —Riverdale, GA
- Part-time
- CPR Certification
- Nursing
- RN License
ED Utilization Management Nurse
University Hospitals —Shaker Heights, OH
- $33.17 - $51.87 an hour
- Holidays
- Nursing
- RN License
- Mid-level
1d
Utilization Management Nurse
TEXAS INDEPENDENCE HEALTH PLAN INC —Austin, TX
- Weekends as needed
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
TX, RN Certified Case Manager - Workers Compensation
The Reny Company —Dallas, TX
- $80,000 - $90,000 a year
- 8 hour shift
- Remote
- Nursing
- RN License
- Research
- Mileage reimbursement
- Disability insurance
Quick Apply
Remote Care Management Nurse
Cambia Health Solutions —Utah
- $38.00 - $41.50 an hour
- Overtime
- Remote
- Background check
- Nursing
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Utilization Review Coordinator
Neuropsychiatric Hospitals —Huber Heights, OH
- Full-time
- Nursing
- Psychiatry
- Mid-level
- Health insurance
- Dental insurance
RN Case Manager, Per Diem (SMH)
UCLA Health —Santa Monica, CA
- $93.83 - $98.52 an hour
- Per diem
- Nursing
- RN License
- BLS Certification
Utilization Management Outpatient Authorization Nurse
Champion Health Plan is a Medicare Advantage Prescription Drug HMO C-SNP serving Medicare beneficiaries with End-Stage Renal Disease. —Long Beach, CA
- From $67,000 a year
- Full-time
- Nursing
- LVN
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
RN Case Manager - Surgery Services
UCLA Health —Los Angeles, CA
- $65.53 - $88.99 an hour
- Nursing
- Surgery
- RN License
Patient Flow Coordinator, RN - Capacity & Transfer Management
WakeMed Health & Hospitals —Raleigh, NC
- Full-time
- Nursing
- RN License
- Hospital
14d
Utilization Specialist
Tower Behavioral Health —Reading, PA
- Full-time
- CPR Certification
- Nursing
- RN License
8d
RN Team Lead Utilization Review
MedStar Health —Clinton, MD
- $89,065 - $162,801 a year
- Full-time
- Nursing
- RN License
- Inpatient
5d

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UM Case Manager/Appeals Coordinator

Havenwyck Hospital (UHS) -
Auburn Hills, MI

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Job Details

Full-time
$60,000 - $69,000 a year

Benefits

Loan repayment program
Health insurance
Dental insurance
401(k)
Flexible spending account
Tuition reimbursement
Paid time off
Employee assistance program
Vision insurance
401(k) matching
Opportunities for advancement
Life insurance
Referral program

Qualifications

Appeals
RN License
LMSW
LPC
Master's degree
Case appeal in utilization management
Bachelor's degree
LBSW
Case management
Substance abuse
Experience working with individuals with substance use disorders
Care plans
Insurance claims appeal handling
Hospital experience

Full Job Description

UM CASE MANAGER/APPEALS COORDINATOR

HAVENWYCK HOSPITAL (a UHS facility)

Havenwyck Hospital is a Joint Commission-accredited and licensed psychiatric hospital, overlooking Lake Galloway in Auburn Hills, Michigan. We specialize in providing comprehensive, compassionate behavioral health services to children, adolescents and adults. It is the ultimate goal of our dedicated staff to build strength, confidence and knowledge within each patient, in hopes that they may continue learning and understanding their needs and practicing self-care for the rest of their lives.

For more information, please visit us at www.havenwyckhospital.com

POSITION SUMMARY:

The Utilization Management Case Manager/ Appeal Coordinator has responsibility for organizing and conducting the managed care process and managing the appeal process. These duties shall be directed toward supporting the hospital's mission in the pursuit of excellence in care/service and will include (but not limited to): conducting timely admission and continued stay record reviews with external payers, utilizing approved criteria to make determinations of medical necessity and level of care planning, verifying active treatment by completing internal audit reviews within approved time frames, assisting the treatment team when indicated in the discharge planning process, and acting as liaison with MD/Clinical Treatment Team and external agencies. Report authorizations, denials, and documentation concerns, as well as collaborate effectively across departments to minimize denials/facilitate optimal use of hospital resources. In addition, this position is responsible for identifying cases for appeal, submitting those appeals, and tracking their status.

QUALIFICATIONS

Bachelor Degree in social work, psychology, counseling or nursing required. Master’s degree in social work, psychology, or counseling preferred.
Valid license in the State of Michigan as a Limited or fully licensed (LBSW, RN, LLMSW, LMSW, LLP, TLLP, LPC, LMFT, etc.) required.
A minimum of 2 years of post-graduate related experience in psychiatric or substance abuse treatment required. Hospital utilization review/utilization management experience preferred
Experience in appeals process required.
Familiarity with managed health care process, medical terminology, experience in case management, discharge planning, and/or utilization review preferred.

If you would like to learn more about this position before applying, please contact Havenwyck Hospital at 248-373-9200.

BENEFIT HIGHLIGHTS:

Challenging and rewarding work environment
Competitive Compensation & Generous Paid Time Off
Excellent Medical, Dental, Vision and Prescription Drug Plan
401(K) with company match and discounted stock plan
Career development opportunities within UHS and its 300+ Subsidiaries
Free Basic Life Insurance
Tuition Reimbursement
SoFi Student Loan Refinancing Program
Student Loan Repayment Program - for some degrees and criteria

What do our current employees value at Havenwyck Hospital and UHS?

An environment that puts patient care first. One of the most rewarding aspects of this job is providing excellent care, comfort, and security to the patients and families you treat, at their most vulnerable times. Supportive and responsive leadership. You are never alone, as you are part of a large network of peer co-workers that routinely exchange ideas and review current topics within the industry. Having the opportunity to grow, learn, and advance in your career. There are very robust continuing education options and opportunities for skills diversification and career advancement with UHS.

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 300 corporation, annual revenues were $15.8 billion in 2024. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies.

Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

Job Type: Full-time

Pay: $60,000.00 - $69,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Employee assistance program
Flexible spending account
Health insurance
Life insurance
Paid time off
Referral program
Tuition reimbursement
Vision insurance

Application Question(s):

What is your desired annual compensation?

Education:

Bachelor's (Required)

Experience:

Post Graduate Psychiatric or Substance Abuse Treatment: 2 years (Required)
Hospital Utilization Review/Utilization Management: 1 year (Preferred)

License/Certification:

LBSW, RN, LLMSW, LMSW, LLP, TLLP, LPC, or LMFT (Required)

Work Location: In person

Quick Apply

Refine Your Search

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UM Case Manager/Appeals Coordinator

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Clinical Review and Appeals Specialist

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Utilization Management Nurse Consultant

Clinical Medical Review Nurse (Remote)

Utilization Management Nurse

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ED Utilization Management Nurse

Utilization Management Nurse

TX, RN Certified Case Manager - Workers Compensation

Remote Care Management Nurse

Utilization Review Coordinator

RN Case Manager, Per Diem (SMH)

Utilization Management Outpatient Authorization Nurse

RN Case Manager - Surgery Services

Patient Flow Coordinator, RN - Capacity & Transfer Management

Utilization Specialist

RN Team Lead Utilization Review

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