Top 6037 Utilization manager rn Jobs

Nurse Case Manager, Utilization Management
1199SEIU Family of Funds —New York, NY
- $89,400 - $106,100 a year
- Full-time
- Nursing
- RN License
- Mid-level
UR Nurse- Remote
Recruitment Specialists, Inc. (RSI) —Hanover, MD
- $45.00 - $46.50 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Acute care experience
Quick Apply
2d
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
Quick Apply
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
Quick Apply
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
Oncology Prior Authorization Case Manager, Non-RN - Remote
University of Miami —Miami, FL
- Full-time
- Remote
- Mid-level
- Bachelor's degree
- Experience equivalent to degree accepted
- 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
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
Clinical Appeals RN
Optum —Boston, MA
- $28.94 - $51.83 an hour
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- AD&D insurance
- Employee stock purchase plan
Oncology RN Case Manager - Remote
Optum —Schaumburg, IL
- $60,200 - $107,400 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
Quick Apply
Manager, Utilization Review
Health Business Solutions LLC —Remote
- Nursing
- RN License
- Mid-level
8d
Utilization Management Manager
Healthfirst —New York, NY
- $99,700 - $168,810 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- 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
CHS Utilization and Appeals Manager
Catholic Health —Melville, NY
- $110,000 - $150,000 a year
- Nursing
- RN License
- Word processing
- Health insurance
- Tuition reimbursement
Telehealth Triage Registered Nurse (RN)
Lumina Care —Remote
- $38 - $45 an hour
- Weekends as needed
- Remote
- Nursing
- Psychiatry
- RN License
- Paid holidays
- Health insurance
Quick Apply
Case Manager, Registered Nurse (Oncology experience required)
CVS Health —Alaska
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
AUSTIN TX Utilization Review RN
Bracane Company —Dallas, TX
- $35 - $40 an hour
- Full-time
- RN License
- Mid-level
- Patient care
Quick Apply
5d
Utilization Review Manager
Assurance Health System, LLC —Remote
- Full-time
- Remote
- Management
- Psychiatry
- RN License
- Health insurance
- 401(k)
Quick Apply
1d
Registered Nurse - Case Manager
SSM Health —Madison, WI
- Part-time
- Nursing
- RN License
- Hospital
- Paid parental leave
- Health insurance

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Nurse Case Manager, Utilization Management

1199SEIU Family of Funds -
New York, NY

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Job Details

Full-time
$89,400 - $106,100 a year

Qualifications

RN License
Medical-surgical
Utilization management
Bachelor of Science in Nursing
Resource utilization in healthcare
Bachelor's degree in nursing

Full Job Description

Requisition #:

7440

# of openings:

Employment Type:

Full time

Position Status:

Permanent

Category:

Non-Bargaining

Workplace Arrangement:

Hybrid

Fund:

1199SEIU National Benefit Fund

Job Classification:

Exempt

Responsibilities

Use industry criteria, benefit plan design, clinical knowledge, and critical thinking to assess, plan and provide, ongoing coordination and management of service delivery through an integrated case management approach
Performs medical necessity review that includes concurrent, prospective, retrospective reviews and 1st level appeals, to ensure compliance with applicable criteria, medical policy, member eligibility, benefits and vendor contracts.
Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization
Maintain accurate records of all patient/provider/vendor related interactions in designated medical management system
Apply clinical guidelines, provide recommendations and discuss cases with Medical Consultants
Meet timelines and quality standards related to Utilization Management
Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures,
Identify and participate in quality improvement activities as it relates to internal programs, processes studies and projects
Authorize vendor services using clinically proven criteria to make consistent care decisions
Maintain compliance with all state mandated regulations
Identify and problem solve issues with appropriate services to ensure positive member outcomes utilizing cost efficient covered services
Responsible for abiding by and supporting the care management programs in order to ensure quality and efficient clinical operations
Perform additional duties and projects as assigned by management

Qualifications

Bachelor’s degree Valid New York State Registered Nurse (RN) required
Minimum three (3) years Medical/Surgical experience plus a minimum of two (2) years Utilization Management experience required
BSN and Certification in Case Management a plus
Proficient in application and use of industry standard Utilization Management criteria (Milliman Care Guidelines), Medicare and coverage guidelines, health claims processing, medical coding
Excellent verbal and written communication skills, problem-solving, clinical assessment, care planning skills, and independent decision-making capability
Computer and organizational skills required, ability to manage competing priorities, multi-task with results-oriented outcomes and work in a fast paced environment. Intermediate skills of Microsoft Office systems preferred.

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Refine Your Search

utilization manager rn jobs

Nurse Case Manager, Utilization Management

UR Nurse- Remote

Denials & Appeals Administrator (RN)

Claims - Care Manager, RN, Claims

Utilization Review Nurse

Care Manager, Concurrent Review (Remote)

Oncology Prior Authorization Case Manager, Non-RN - Remote

RN Case Manager

Clinical Review & Correspondence RN

Clinical Appeals RN

Oncology RN Case Manager - Remote

Manager, Utilization Review

Utilization Management Manager

Utilization Review RN

CHS Utilization and Appeals Manager

Telehealth Triage Registered Nurse (RN)

Case Manager, Registered Nurse (Oncology experience required)

AUSTIN TX Utilization Review RN

Utilization Review Manager

Registered Nurse - Case Manager

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