Top 8431 Rn Utilization Management Jobs

Utilization Management Nurse
TEXAS INDEPENDENCE HEALTH PLAN INC —Austin, TX
- Weekends as needed
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Travel RN-Utilization Review Specialist-Day/Nights-36 Hours-Duluth, GA-$3,085.00
Prolink —Duluth, GA
- $3,085 a week
- Night shift
- Background check
- Vital signs
- RN License
- Health insurance
- Dental insurance
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3d
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
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Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
- Nursing
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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
- Customer service
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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 - 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
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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
13d
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
Utilization Review RN - Case Management
Swedish Health Services —Seattle, WA
- $52.26 - $81.13 an hour
- Day shift
- Nursing
- RN License
- Hospital
- Paid parental leave
- Paid holidays
RN - Utilization Management
Piedmont Healthcare Inc. —Atlanta, GA
- Full-time
- Remote
- Nursing
- RN License
- Bachelor of Science
3d
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
Quick Apply
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
MDS Coordinator LPN/RN
Hallmark Healthcare of Carlinville —Carlinville, IL
- $35 - $50 an hour
- Online Application
- In person
- RN License
- Mid-level
- LPN
- Health insurance
- Dental insurance
Quick Apply
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
- Dental insurance
RN - Assistant Nurse Manager (3p-11p) W3 Oncology - Kingsport, TN
Ballad Health —Kingsport, TN
- Full-time
- Nursing
- RN License
- PALS Certification
MDS Coordinator, RN
Confidential —Spartanburg, SC
- Full-time
- Background check
- Anatomy knowledge
- Skilled nursing facility
- Free parking
- Disability insurance
Quick Apply

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Utilization Management Nurse

TEXAS INDEPENDENCE HEALTH PLAN INC -
Austin, TX

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Job Details

Full-time

Qualifications

Nursing
Microsoft Excel
Microsoft Outlook
Medicare
LVN
RN License
Managed care organization experience
Word embeddings
Medicaid health insurance
Utilization management
Resource utilization in healthcare
Acute care experience

Full Job Description

Primary Responsibilities

The Utilization Management Nurse will determine the medical appropriateness of inpatient and outpatient services by evaluating medical guidelines, benefit determination and compliance with state mandated regulations.

Essential Functions

Perform concurrent, retroactive and pre-service authorization reviews for inpatient and outpatient services.
Follow and maintain compliance with CMS requirements, may include after-hours, holiday and weekend coverage.
Collaborate with staff, physicians, care/service coordinators, and medical directors to coordinate and provide the level of care necessary to meet member’s health need.

Educational/Training Requirements

Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience.
Payor Utilization Management: 3 years recommended experience
Proficiency with Microsoft Office applications, specifically Word, Excel, and Outlook
Proficiency using Milliman Care Guidelines (MCG) and/ or InterQual criteria.

Licensing Requirements

Current unencumbered LVN or RN license in Texas or compact license.

Experience Requirements

2+ years Utilization management experience with a health insurance company (managed care/payer experience required).
UM for Medicare Advantage, Managed Medicaid, Dual SNP Lines of Business, on the payer side.
5+ years of acute clinical experience.
The ability to effect change, perform critical analyses, promote positive outcomes, and facilitate empowerment for members/families.

Location

This position is remote, but requires the employee to live within our service area which can include any of the following areas within Texas: Rio Grande Valley, DFW, greater Austin, greater Houston, greater San Antonio, Coastal Bend, or Laredo.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Location: Hybrid remote in Austin, TX 78789

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Refine Your Search

Rn Utilization Management jobs

Utilization Management Nurse

Travel RN-Utilization Review Specialist-Day/Nights-36 Hours-Duluth, GA-$3,085.00

Utilization Management Nurse I, RN

Utilization Review RN

RN Utilization Management

Concurrent Utilization Review Nurse, RN

Utilization Management Nurse

Remote Home Health RN – Medical Claims Reviewer

Utilization Management Registered Nurse

RN - Utilization Management - MGH

Denials & Appeals Administrator (RN)

Utilization Review RN

Utilization Review RN - Case Management

RN - Utilization Management

RN Director of Care Management - Sign-On Bonus Eligible

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

MDS Coordinator LPN/RN

Registered Nurse Traveler Cath Lab Multiple Shifts Available

RN - Assistant Nurse Manager (3p-11p) W3 Oncology - Kingsport, TN

MDS Coordinator, RN

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