Top 6704 Utilization management rn Jobs

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
Medical Management - Utilization Management RN 145-2026
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
9d
Medical Management - Utilization Management RN 145-2011
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
9d
Utilization Review RN, Case Management/UR, Full Time, Day Shift, Job ID # 1815702
Palmetto General Hospital —Hialeah, FL
- Full-time
- Microsoft Outlook
- RN License
- Computer literacy
11d
RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare —California
- $30.37 - $59.21 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Discharge planning
- Health insurance
Utilization Management Registered Nurse (RN) - Remote
Guidehealth —Chicago, IL
- $70,000 - $75,000 a year
- Full-time
- Remote
- Microsoft Word
- Nursing
- Microsoft Excel
- Paid parental leave
- Disability insurance
12d
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
Quick Apply
Utilization Management Nurse RN
Signature Consulting Services LLC —Louisville, KY
- $75,000 - $82,000 a year
- 8 hour shift
- Remote
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
RN - Case Manager - AS Utilization Management - Part Time - 8 Hour - Days
John Muir Health —Walnut Creek, CA
- $89.23 - $121.58 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
Utilization Management Clinician - CCR
Capital Blue Cross —Harrisburg, PA
- $32.50 - $61.22 an hour
- Full-time
- Remote
- Addiction Medicine
- RN License
- Writing skills
- Paid holidays
- 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
11d
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 Lead
Humana —Michigan
- $94,900 - $130,500 a year
- Full-time
- Remote
- Nursing
- RN License
- Master's degree
- Paid parental leave
- Paid holidays
10d
Registered Nurse / RN - Utilization Management I
CareOregon —Portland, OR
- $102,330 - $125,070 a year
- Full-time
- RN License
- Customer service
- Computer literacy
- Wellness program
- Paid jury duty
Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
- Nursing
Quick Apply
Sr. Director, Ambulatory RNs
UT Southwestern —Dallas, TX
- Full-time
- Nursing
- RN License
- 5 years
- Paid parental leave
- Paid holidays
Clinical Reimbursement Specialist (MDS) - Groves Center-3K retention bonus
The Groves Center —Lake Wales, FL
- Full-time
- Background check
- CPR Certification
- Microsoft Outlook
- Health insurance
- Dental insurance
Clinical Coordinator (RN) - Part Time with Benefits
RestorixHealth —Redfield, SD
- Part-time
- Nursing
- RN License
- BLS Certification
- Health savings account
- AD&D insurance
Quick Apply
RN Case Manager - Day Shift - Sign-on Bonus
ChristianaCare —Newark, DE
- $41.28 - $66.05 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Paid parental leave
- Health insurance
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
9d

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Utilization Management Clinical Reviewer

CuraFi
Remote

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Job Details

Full-time
$140,000 - $160,000 a year
11 days ago

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Life insurance

Qualifications

Strategic management
Teamwork
RN License
Attention to detail
Documentation review

Full Job Description

CuraFi is a fast-paced healthcare technology startup helping providers, ACOs, RBOs, and payers improve utilization management, prior authorization workflows, specialty drug management, referral management, care coordination, and provider engagement.

We are looking for an experienced RN with strong critical thinking skills, with the ability to analyze clinical and operational decisions through both a business value and clinical integrity lens. This is a hybrid leadership and hands-on operations role. Approximately 50% of the role will involve direct review and processing of clinical cases, while the remaining time will focus on team oversight, workflow improvement, provider engagement, guideline development, and product collaboration.

Key Responsibilities

Lead and manage a clinical operations team of pharmacists, RNs, and other clinical staff.
Spend approximately 50% of time directly performing hands-on clinical operations work, including reviewing and processing medical records, claims, and lab/imaging results to determine diagnostic accuracy, UM cases, prior authorization requests, case reviews, provider outreach tasks, documentation checks, and guideline-based determinations.
Critically analyze clinical, operational, and business tradeoffs to drive measurable value for CuraFi’s customers while maintaining clinical integrity, compliance, and patient-centered decision-making.
Operational oversight over utilization management workflows, prior authorization reviews, case reviews, provider outreach, and network development activities.
Support development and maintenance of clinical guidelines, utilization criteria, specialty drug policies, and clinical review protocols.
Set up strategic communications and partnerships with providers, medical groups, payers, and internal teams to improve workflows, reduce administrative burden, and resolve case-level issues.
Support network development efforts, including provider engagement, specialist routing, referral workflows, and performance improvement initiatives.
Identify workflow gaps, operational bottlenecks, quality issues, and opportunities for automation or product improvement.
Project manage and set up internal SOPs and obtain/keep current certifications such as NCQA, URAC accreditation
Work closely with product, engineering, and leadership teams to translate clinical and operational needs into product requirements.
Train, coach, and support clinical team members in a fast-changing startup environment.
Track operational metrics, quality outcomes, SLA performance, provider response rates, and case review trends.
Support audits, compliance reviews, documentation standards, and process improvement initiatives.

Ideal Candidate

Active RN license.
Experience in utilization management, prior authorization, case management, managed care, payer operations, ACO/RBO operations, or provider group operations.
Strong understanding of Medicare, CMS requirements, specialty drugs, referrals, provider workflows, and clinical documentation.
Experience managing or mentoring clinical teams.
Comfortable reviewing complex clinical cases and applying medical policy or evidence-based criteria.
Strong communication skills with providers, clinical staff, payers, and internal product/engineering teams.
Able to move between strategy and execution: building processes while also jumping into day-to-day operational work.
Highly organized, detail-oriented, and comfortable working in a fast-paced startup environment.
Comfortable with technology, workflow tools, spreadsheets, clinical platforms, and AI-enabled clinical operations.

Preferred Qualifications

Experience working with pharmacists or multidisciplinary clinical review teams.
Experience with Medicare Advantage, Part B drugs, Part D drugs, specialty pharmacy, delegated UM, or provider network management.
Experience developing clinical guidelines, medical policies, or utilization criteria.
Prior startup, health tech, payer, MSO, IPA, ACO, or value-based care experience.
Familiarity with NCQA, CMS ODAG/CDAG, HIPAA, audit readiness, and clinical quality processes.

Why Join CuraFi

This is a high-impact role for someone who wants to help build the clinical operating model for a growing healthcare startup. You will shape workflows, lead clinical teams, support provider-facing operations, influence product development, and directly improve how providers and payers manage complex care.

Pay: $140,000.00 - $160,000.00 per year

Benefits:

401(k)
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Work Location: Remote

Quick Apply

Refine Your Search

utilization management rn jobs

Utilization Management Clinical Reviewer

Medical Management - Utilization Management RN 145-2026

Medical Management - Utilization Management RN 145-2011

Utilization Review RN, Case Management/UR, Full Time, Day Shift, Job ID # 1815702

RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)

Utilization Management Registered Nurse (RN) - Remote

Concurrent Utilization Review Nurse, RN

Utilization Management Nurse RN

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

Utilization Management Clinician - CCR

Health Nurse - Utilization Management

Denials & Appeals Administrator (RN)

Utilization Management Nurse Lead

Registered Nurse / RN - Utilization Management I

Utilization Management Nurse

Sr. Director, Ambulatory RNs

Clinical Reimbursement Specialist (MDS) - Groves Center-3K retention bonus

Clinical Coordinator (RN) - Part Time with Benefits

RN Case Manager - Day Shift - Sign-on Bonus

Director of Nursing (DON) - Full-Time Exempt

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