Top 8963 Utilization Management R.n. Jobs

RN / Medical Reviewer / Remote
InGenesis —Columbia, SC
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
Utilization Management Clinician I
Community Health Plan of Washington —Seattle, WA
- $35.92 - $55.67 an hour
- Full-time
- Mid-level
- Analysis skills
- Critical & Intensive Care
- Paid jury duty
- Health savings account
Quick Apply
Medical Management - Utilization Management RN 145-2026
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
4d
Medical Management - Utilization Management RN 145-2011
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
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
Utilization Management Registered Nurse
West Coast Consulting —Remote
- $30 - $34 an hour
- Contract
- Remote
- RN License
- Mid-level
- Nursing
- 401(k)
Quick Apply
4d
Clinical Financial Case Management RN
The Ohio State University —Remote
- Full-time
- Remote
- Background check
- Nursing
- Microsoft Excel
Utilization Management Nurse Consultant
CVS Health —New Jersey
- $32.01 - $68.55 an hour
- Weekends as needed
- Remote
- RN License
- Computer literacy
- Mid-level
- Health insurance
- Dental insurance
14d
Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
Quick Apply
Clinical Denials Specialist
Firstsource Healthcare —Remote
- Monday to Friday
- Remote
- RN License
- HIPAA
- Research
- Health insurance
- Dental insurance
Clinical Documentation Specialist
Managed Resources, Inc (MRI) —Remote
- $32 - $45 an hour
- Full-time
- Remote
- Anatomy knowledge
- RN License
- Mid-level
- Paid holidays
- Health insurance
5d
Utilization Review Nurse
Health Business Solutions LLC —Remote
- Remote
- Nursing
- RN License
- Bachelor of Science
6d
Utilization Management RN (Hybrid)
TEXASCONNECT INC —Dallas, TX
- Weekends as needed
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Relocation assistance
Clinical Review & Correspondence RN
Cohere Health —Remote
- $31 - $35 an hour
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Health savings account
Quick Apply
Program Manager - Cardiac Rehabilitation
SouthEast Alaska Regional Health Consortium —Juneau, AK
- $36.46 - $51.29 an hour
- Full-time
- Microsoft Excel
- Computer literacy
- BLS Certification
- Paid parental leave
- Disability insurance
Quick Apply
Registered Nurse - Case Manager
SSM Health —Madison, WI
- Part-time
- Nursing
- RN License
- Hospital
- Paid parental leave
- Health insurance
MEDICAL RENAL RN (H 6 MAIN)
Covenant HealthCare —Saginaw, MI
- Full-time
- Nursing
- RN License
- Hospital
SURGICAL INTENSIVE CARE UNIT RN
Covenant HealthCare —Saginaw, MI
- Full-time
- Nursing
- Microsoft Outlook
- Surgery
Nurse Educator (RN)
Wake Robin Corporation —Shelburne, VT
- $36.70 - $44.77 an hour
- Weekends as needed
- Nursing
- RN License
- Mid-level
- 403(b) matching
- Disability insurance
Quick Apply
Director of Nursing (DON) - Full-Time Exempt
River's Bend Health Services —Manitowoc, WI
- Up to $120,000 a year
- Weekends as needed
- CPR Certification
- Nursing
- Skilled nursing facility
Quick Apply
4d

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Utilization Management R.n. jobs near

RN / Medical Reviewer / Remote

InGenesis -
Columbia, SC

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Job Details

Full-time

Qualifications

RN License

Full Job Description

RN / Medical Reviewer / Remote

Job Details

Professional Discipline :

Registered Nurse

Specialty :

Utilization Review

Employment Type :

Full Time

City :

Columbia

State :

Pay Range :

Job Description:

InGenesis is currently seeking a Registered Nurse / RN - Managed Care Coordinator to work for our client located in Columbia, SC. In this role you will review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria and assess and monitor medical necessity using your clinical proficiency and claims knowledge.

This is a REMOTE opportunity for candidates living in the state of South Carolina! Apply today and we’ll reach out to answer any questions you may have.

Job Duties

Perform medical review/authorization process.
Ensure coverage for appropriate services within benefit and medical necessity guidelines.
Assess service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans.
Evaluate outcomes of plans, eligibility, level of benefits, place of service, length of stay and medical necessity regarding requested services and benefit.
Ensure accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits.
Utilize allocated resources to back up review determinations.
Identify and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.).
Participate in data collection/input into system for clinical information flow and proper claims adjudication
Perform other duties as assigned.

Minimum Qualifications

Current Registered Nurse / RN license in the State of South Carolina.
Associates degree in nursing or graduate from accredited nursing school.
4 years of clinical experience in specialty areas like: oncology, cardiology, neonatology, maternity, rehab, mental health/chemical dependency or surgery. OR
4 years of utilization review/case management or combination of clinical experience.

EEO Statement:
InGenesis is an equal opportunity employer committed to fostering a diverse, inclusive, and equitable workplace. We comply with all applicable federal, state, and local employment laws, including recent executive orders, and strictly prohibit discrimination, harassment, or retaliation based on race, color, religion, sex, sexual orientation, gender identity, national origin, disability, genetic information, age, veteran status, or any other characteristic protected by law.

InGenesis is dedicated to making reasonable accommodations for qualified individuals with disabilities and ensuring that all employment decisions are based on qualifications, merit, and business needs. If you require a reasonable accommodation during the hiring process, please contact us by visiting our website at https://www.ingenesis.com/careers/site-accommodations.

To learn more about your rights, please refer to the Know Your Rights: Workplace Discrimination is Illegal poster issued by the U.S. Equal Employment Opportunity Commission (EEOC).

Company Statement:
With decades of experience, InGenesis has grown into one of North America’s most trusted Healthcare Services Firms, which includes comprehensive health and workforce solutions. As the industry landscape shifts with new challenges in patient care, quality and compliance requirements, workforce retention, and operational efficiencies, we deliver strategic, data-driven solutions that include redefining workforce management and clinical service delivery. Explore InGenesis to discover how our expertise, innovative strategies, and commitment to excellence are shaping the future of healthcare workforce solutions. Join us in celebrating the professionals who define the next era of healthcare.

Apply Now

Refine Your Search

Utilization Management R.n. jobs

RN / Medical Reviewer / Remote

Utilization Management Clinician I

Medical Management - Utilization Management RN 145-2026

Medical Management - Utilization Management RN 145-2011

Denials & Appeals Administrator (RN)

Utilization Management Registered Nurse

Clinical Financial Case Management RN

Utilization Management Nurse Consultant

Claims - Care Manager, RN, Claims

Clinical Denials Specialist

Clinical Documentation Specialist

Utilization Review Nurse

Utilization Management RN (Hybrid)

Clinical Review & Correspondence RN

Program Manager - Cardiac Rehabilitation

Registered Nurse - Case Manager

MEDICAL RENAL RN (H 6 MAIN)

SURGICAL INTENSIVE CARE UNIT RN

Nurse Educator (RN)

Director of Nursing (DON) - Full-Time Exempt

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