Top 4861 Utilization Manager Rn Jobs

Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
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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
RN Reviewer
Cohere Health —Remote
- $33 - $35 an hour
- Full-time
- Remote
- Google Workspace
- Nursing
- RN License
- Paid parental leave
- Health savings account
Quick Apply
Utilization Review Manager - PRN
Assurance Health System, LLC —Remote
- Part-time
- Remote
- Psychiatry
- RN License
- Mid-level
- Health insurance
- 401(k)
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5d
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
RN MDS Coordinator/Case Manager
Lake Forest Health & Rehabilitation —Smithfield, RI
- $45 - $48 an hour
- Full-time
- Anatomy knowledge
- RN License
- Mid-level
- Disability insurance
- Health insurance
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6d
Staff Nurse - Case Manager
Skagit Regional Health —Mount Vernon, WA
- $40.54 - $73.92 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Disability insurance
- Health insurance
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Registered Nurse - Case Manager
SSM Health —Lake Saint Louis, MO
- Part-time
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Health insurance
Sr. Director, Ambulatory RNs
UT Southwestern —Dallas, TX
- Full-time
- Nursing
- RN License
- 5 years
- Paid parental leave
- Paid holidays
Patient Care Manager 3D/3E/Burn
Arkansas Children's Hospital —Little Rock, AR
- Full-time
- Nursing
- Surgery
- RN License
LTSS Service Coordinator - RN Clinician
Elevance Health —Lubbock, TX
- Nursing
- RN License
- Experience working with individuals with disabilities
- Employee stock purchase plan
- Paid holidays
13d
RN Manager - Case Management
Valley Medical Center —Renton, WA
- From $47.48 an hour
- Full-time
- Acute care
- Background check
- Nursing
- Free parking
- Health insurance
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Nurse Manager
Betty Dare Wellness and Rehabilitation —Alamogordo, NM
- $32 - $45 an hour
- Full-time
- Background check
- Nursing
- Skilled nursing facility
- Health insurance
- Dental insurance
Quick Apply
Assistant Nurse Manager, Intensive Care Unit
Oregon Health & Science University —Portland, OR
- $103,334 - $175,614 a year
- Extended hours
- Background check
- Nursing
- RN License
- Travel reimbursement
- Wellness program
Registered Nurse Team Director (RN)
Moments Hospice —St. Louis, MO
- $90,000 - $100,000 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Dental insurance
- Paid time off
Quick Apply
12d
Surgery Center RN Manager
Southdale Specialty Surgery Center —Minneapolis, MN
- $110,000 - $133,000 a year
- Full-time
- Nursing
- RN License
- 5 years
- Health insurance
- Dental insurance
Quick Apply
RN Manager – In-Home Care Services | M-F Days
Immanuel —Omaha, NE
- 8 hour shift
- Background check
- Nursing
- RN License
- Wellness program
- Health savings account
8d
Manager Behavioral Health
CHRISTUS Health (IHE/Hosted) —Longview, TX
- $49,886.84 - $60,078.78 a year
- 8 hour shift
- Nursing
- PALS Certification
- Hospital
- Relocation assistance
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Director, Utilization Management & Operational Integrity
Medical Mutual of Ohio —Cleveland, OH
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- Disability insurance
Case Manager - (OT, PT, RN, RRT, SLP, LSW) FT Days | Overland Park Rehab
PAM Health, LLC —Overland Park, KS
- Full-time
- RN License
- Hospital
- BLS Certification
- Health savings account
- Disability insurance
Quick Apply

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Claims - Care Manager, RN, Claims

Wellcove
Remote

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Job Details

Full-time

Qualifications

RN License

Full Job Description

Who We Are
Wellcove has been recognized as the nation’s leading full-service senior market solutions provider for over 25 years. Our solutions span the insurance senior market sector, focusing on long-term care and Medicare Supplement plans. However, we don’t stop there. Wellcove also addresses challenges faced in accident & health, disability, and supplemental health insurance programs.

Our team provides individuals and their families with peace of mind knowing their insurance needs will be met in a thoughtful, efficient manner. We are able to do this because of our dedicated associates, innovative solutions, and state-of-the-art technology.

We are seeking an experienced Registered Nurse (RN) to serve as a Care Manager supporting Long Term Care (LTC) insurance claims. This individual contributor role is responsible for conducting comprehensive clinical eligibility reviews to determine whether policyholders meet the benefit eligibility requirements outlined in their LTC policy.
The Care Manager, RN will complete and document Chronically Ill Certifications (CICs) and develop Plans of Care (POCs) for initial claims and ongoing recertifications, ensuring determinations are clinically sound, and policy aligned.

Key Responsibilities

Perform detailed clinical reviews of LTC claim files to determine eligibility in accordance with policy provisions and regulatory requirements.
Assess Activities of Daily Living (ADLs), cognitive impairment, diagnoses, comorbidities, and level of care needs.
Review medical records, Minimum Data Set (MDS) assessments, facility documentation, home health records, daily visit notes, and supporting claim forms.
Determine whether the insured meets the policy definition of Chronically Ill.
Prepare and document Chronically Ill Certifications (CICs) and individualized Plans of Care (POCs) for initial approvals and recertifications.
Clearly document clinical rationale to support benefit determinations.
Collaborate with Claims, Eligibility, and Customer Service teams to obtain additional documentation when necessary.
Maintain knowledge of LTC policy language, benefit triggers, and regulatory requirements.

Qualifications

Active, unrestricted Registered Nurse (RN) license required.
Clinical experience in long-term care, home health, geriatrics, case management, or utilization review preferred.
Experience reviewing medical records and assessing functional and cognitive impairment.
Knowledge of LTC insurance benefit triggers, ADL requirements, and chronically ill certification standards preferred.
Strong clinical judgment, critical thinking, and documentation skills.
Ability to manage multiple cases and meet turnaround expectations.

At Wellcove, we strive to create an inclusive culture for all. We understand the importance of listening and incorporating various perspectives at every level of service. Our company does not discriminate based on gender identity, race, sexual orientation, age, religion, or disability.

Quick Apply

Refine Your Search

Utilization Manager Rn jobs

Claims - Care Manager, RN, Claims

Denials & Appeals Administrator (RN)

RN Reviewer

Utilization Review Manager - PRN

Care Manager, Concurrent Review (Remote)

RN MDS Coordinator/Case Manager

Staff Nurse - Case Manager

Registered Nurse - Case Manager

Sr. Director, Ambulatory RNs

Patient Care Manager 3D/3E/Burn

LTSS Service Coordinator - RN Clinician

RN Manager - Case Management

Nurse Manager

Assistant Nurse Manager, Intensive Care Unit

Registered Nurse Team Director (RN)

Surgery Center RN Manager

RN Manager – In-Home Care Services | M-F Days

Manager Behavioral Health

Director, Utilization Management & Operational Integrity

Case Manager - (OT, PT, RN, RRT, SLP, LSW) FT Days | Overland Park Rehab

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