Top 4935 Rn utilization manager Jobs

RN In Hospital Transition of Care Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- Psychiatry
Quick Apply
RN In Hospital Transiton of Care Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Background check
- Nursing
- Microsoft Excel
Quick Apply
RN Case Manager - Complex Cases
UCLA Health —Santa Monica, CA
- $65.53 - $84.75 an hour
- Nursing
- RN License
- BLS Certification
RN Case Manager, Per Diem (SMH)
UCLA Health —Santa Monica, CA
- $93.83 - $98.52 an hour
- Per diem
- Nursing
- RN License
- BLS Certification
RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days
John Muir Health —Walnut Creek, CA
- $89.23 - $121.58 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
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
Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
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RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days
John Muir Health —Concord, CA
- $89.23 - $121.58 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
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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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
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Utilization Review Nurse
Cobalt Benefits Group LLC —Dallas, TX
- $90,000 - $98,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- AD&D insurance
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RN Concurrent Review - UM - Remote - Kelsey Seybold Clinic
Optum —Pearland, TX
- $60,200 - $107,400 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
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Case Manager, Registered Nurse (Oncology experience required)
CVS Health —Indiana
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
Utilization Review RN
Beth Israel Lahey Health —Boston, MA
- $38.11 - $98.61 an hour
- Full-time
- Nursing
- RN License
- Hospital
Registered Nurse - Case Manager
SSM Health —Lake Saint Louis, MO
- Part-time
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Health insurance
Market Physician Executive (MPE) - Atlanta, GA
Monogram Health Professional Services —Atlanta, GA
- On call
- Medicine
- Critical & Intensive Care
- Travel
- Health insurance
- Dental insurance
Quick Apply
Sr. Director, Ambulatory RNs
UT Southwestern —Dallas, TX
- Full-time
- Nursing
- RN License
- 5 years
- Paid parental leave
- Paid holidays
Market Physician Executive (MPE)
Monogram Health Professional Services —Atlanta, GA
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
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
Quick Apply
Market Physician Executive (MPE) - Float
Monogram Health Professional Services —Georgia
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply

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RN In Hospital Transition of Care Case Manager

MedStar Health -
Washington, DC

Quick Apply

Job Details

Full-time
$89,065 - $162,801 a year

Qualifications

RN License
Managing patients as a nurse case manager
Utilization management
Decision making
Resource utilization in healthcare

Full Job Description

About this Job:

General Summary of Position

An exciting new role has been added to the team, offering a unique opportunity to make a direct impact on patient outcomes at a critical point in care. The In-Hospital Transition of Care RN Case Manager partners closely with hospital discharge planners to coordinate patient care at discharge, ensuring seamless continuity across care settings and reducing avoidable readmissions through proactive coordination, patient education, and timely follow-up.

This position is based at either Washington Hospital Center or The Psychiatric Institute of Washington (PIW) and offers the opportunity to work across diverse patient populations, with flexibility to provide coverage at both locations.

In this highly collaborative and autonomous role, the RN Case Manager manages a complex caseload and takes ownership of case management program(s), driving high-quality, cost-effective outcomes while enhancing the patient experience. The role includes coordinating and managing care for members/enrollees, completing pre-authorization reviews to ensure medical necessity and timely access to services, and conducting pharmacy reviews aligned with the population served. Working alongside an interdisciplinary team, you will play a key role in discharge planning, connecting patients to the right resources, and ensuring smooth transitions across the continuum of care.

This is an excellent opportunity for a nurse who thrives in a fast-paced environment, values critical thinking and autonomy, and is passionate about improving care transitions and patient outcomes. We are committed to fostering a supportive, inclusive environment where associates from diverse backgrounds can grow, advance, and make a meaningful difference.

Primary Duties and Responsibilities

Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Actively develops and manages complex case management cases and develops individualized plans of care according to NCQA standards/ guidelines and the District of Columbia Contract.
Acts as a liaison to MedStar Family Choice contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care.
Acts as an advocate while assisting members/enrollees to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy.
Assists hospital case management staff with discharge planning if applicable. Makes recommendation to alternate tier of Case Management programs or level of care as acuity necessitate.
Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups District/ community agencies meetings etc. as assigned. Provides input completes assignments and shares new findings with other staff. Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Provides face to face case management in the community as the member/enrollee's health necessitate.
Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
Demonstrates skill and flexibility in providing coverage for other staff.
For assigned Case Management program(s) develops strategies assessment(s) and evaluation/goal tools according to NCQA standards/ guidelines and District of Columbia Contract for the population served. Utilizes standards/ guidelines to manage and document interactions for the program (s). Responsible for verifying that assigned program utilizes up-to-date standards in the medical and behavioral health community for the population served. Keeps informed about disease processes treatment modalities and resources.
Identifies and reports potential coordination of benefits subrogation third party liability worker's compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel.
Identifies inpatients requiring additional services and initiates care with appropriate practitioners.
Maintains current knowledge of MFC benefits and enrollment issues in order to accurately coordinate services.
Maintains timely and accurate documentation in the clinical software system per Clinical Operation department's policy.
Monitors utilization of all services for fraud waste and abuse.
Performs telephonic ACD line coverage for Clinical Operations' needs.
Enters authorization as appropriate to the program and sends the reviews to Medical Director as appropriate. Coordinates review decisions and notifications per policy NCQA standards/ guidelines and District of Columbia Contract for timely decision making.
Participates in meetings and on committees and represents the department and hospital in community outreach efforts.
Participates in multi-disciplinary quality and service improvement teams.

Minimal Qualifications
Education

Graduate of an accredited School of Nursing required and
Bachelor's degree preferred

Experience

1-2 years Case management experience required and
1-2 years UM or related experience required and
3-4 years Diverse clinical experience required

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia and/or the State of Maryland based on work location(s) Upon Hire required and
CCM - Certified Case Manager Upon Hire preferred

Knowledge Skills and Abilities

Verbal and written communication skills. Ability to use computer to enter and retrieve data. Ability to create edit and analyze Microsoft office (Word Excel and PowerPoint) preferred.

This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr.

Work Location: In person

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Refine Your Search

rn utilization manager jobs

RN In Hospital Transition of Care Case Manager

RN In Hospital Transiton of Care Case Manager

RN Case Manager - Complex Cases

RN Case Manager, Per Diem (SMH)

RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days

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Claims - Care Manager, RN, Claims

RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days

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Clinical Review & Correspondence RN

Utilization Review Nurse

RN Concurrent Review - UM - Remote - Kelsey Seybold Clinic

Case Manager, Registered Nurse (Oncology experience required)

Utilization Review RN

Registered Nurse - Case Manager

Market Physician Executive (MPE) - Atlanta, GA

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