Top 8208 Utilization management rn Jobs

Care Review Clinician (RN) - Remote in FL
Molina Healthcare, Inc. —Florida
- $26.41 - $51.49 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
Care Review Clinician (RN) - Remote in FL
Molina Healthcare, Inc. —Saint Petersburg, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
Care Review Clinician (RN) - Remote in FL
Molina Healthcare, Inc. —Miami, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
Health Nurse - Utilization Management
Alterwood Health —Remote
- $75,000 - $95,000 a year
- Full-time
- Microsoft Word
- Background check
- Nursing
- Health savings account
- Disability insurance
Quick Apply
12d
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 Nurse
Brighton Health Plan Solutions, LLC —Remote
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
12d
Medical Management - Utilization Management RN 145-2026
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
9d
ISNP Utilization Management Nurse
Longevity Health —Remote
- Full-time
- Nursing
- Clean driving record
- RN License
Quick Apply
9d
Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
- Nursing
Quick Apply
Utilization Management Clinical Reviewer
CuraFi —Remote
- $140,000 - $160,000 a year
- Full-time
- RN License
- Senior level
- Communication skills
- Health insurance
- Dental insurance
Quick Apply
11d
Clinical Auditor I-Nurse
WellSense Health Plan —Remote
- $64,000 - $93,000 a year
- Full-time
- Nursing
- RN License
- Bachelor's degree
- Health insurance
- Dental insurance
Utilization Review Nurse
Health Business Solutions LLC —Remote
- Remote
- Nursing
- RN License
- Bachelor of Science
11d
Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
Quick Apply
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
Utilization Review Nurse
Umpqua Health —Remote
- $85,000 - $105,340 a year
- Full-time
- Bilingual
- Nursing
- RN License
- Health insurance
- Dental insurance
Nurse Specialist II
Qlarant —Remote
- $56,055 - $83,665 a year
- Full-time
- Remote
- RN License
- Mid-level
- Bachelor's degree
Quick Apply
Clinical Review Nurse
TurningPoint Healthcare Solutions, LLC —Remote
- $52,000 - $68,000 a year
- Remote
- Nursing
- RN License
- Computer literacy
Quick Apply
Clinical Denials and Appeals Specialist
UASI —Remote
- Remote
- Microsoft Word
- Nursing
- RN License
- Disability insurance
- Health insurance
10d
Utilization Management Nurse Consultant
CVS Health —Pennsylvania
- $29.10 - $62.32 an hour
- Weekends as needed
- Remote
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
RN Case Manager
Zócalo Health —Remote
- $85,000 a year
- Full-time
- Remote
- RN License
- Writing skills
- Mid-level
- Health insurance
- Dental insurance

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Care Review Clinician (RN) - Remote in FL

Molina Healthcare, Inc. -
Florida

Apply Now

Job Details

Full-time
$26.41 - $51.49 an hour

Benefits

Health insurance

Qualifications

Inpatient experience
RN License
Managed care organization experience
Acute care facility experience
Pre-authorization review for utilization management
Productivity software

Full Job Description

JOB DESCRIPTION

Must reside in Florida

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote the Molina care model.
Adheres to utilization management (UM) policies and procedures.

Required Qualifications

At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

Certified Professional in Healthcare Management (CPHM).
Recent hospital experience in an intensive care unit (ICU) or emergency room.

Utilization Management (UM) experience highly preferred.

#PJHS3

#LI-AC1

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Apply Now

Refine Your Search

utilization management rn jobs

Care Review Clinician (RN) - Remote in FL

Care Review Clinician (RN) - Remote in FL

Care Review Clinician (RN) - Remote in FL

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Utilization Management Nurse

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Utilization Management Nurse

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Utilization Review Nurse

Claims - Care Manager, RN, Claims

Clinical Review & Correspondence RN

Utilization Review Nurse

Nurse Specialist II

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Clinical Denials and Appeals Specialist

Utilization Management Nurse Consultant

RN Case Manager

I want to receive the latest job alert for utilization management rn

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