Top 8 Utilization review nurse Jobs in Saint Louis, Mi

RN Care Management Program Specialist
OpTech LLC —Michigan
- $37 - $39 an hour
- Full-time
- Remote
- Background check
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
1d
Psychiatric Care Specialist RN
MyMichigan Health —Midland, MI
- Full-time
- Nursing
- Current TB test
- Psychiatry
RN Field Case Manager
Hope At Home Health Care —Mount Pleasant, MI
- Up to $100,000 a year
- Weekends as needed
- Nursing
- Management
- RN License
- Health insurance
- Flexible spending account
Quick Apply
Travel Case Management RN
Fastaff —United States
- Up to $2,826 a week
- Full-time
- Background check
- Nursing
- RN License
- Mileage reimbursement
- Health savings account
Quick Apply
4d

Related jobs to explore

Based on your search for utilization review nurse

MDS Coordinator | RN Registered Nurse
NexCare WellBridge Senior Living —Saint Louis, MI
With a thorough knowledge of state and federal regulations, you will provide key leadership and contributions in ensuring compliance to requirements.
Quick Apply
1d
Wellness Director
Leisure Living —Alma, MI
Manage all appropriate state regulations and auditing to ensure our community is in compliance. While performing the duties of this job, the employee is…
Quick Apply

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
Registered Nurse Care Coordinator - Fostering Connections Clinic (PFK)
Nationwide Children's Hospital —Columbus, OH
Valid Ohio driver’s license and proof of auto insurance as required by hospital policy. Pediatric certification, Advanced-Continuity of Care Certification (A-…
8d

Show more jobs in cities nearby

I want to receive the latest job alert for utilization review nurse in saint louis, mi

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization review nurse jobs near saint louis, mi

RN Care Management Program Specialist

OpTech LLC -
Michigan

Quick Apply

Job Details

Full-time
$37 - $39 an hour
1 day ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Case assessment
RN License
CMS
CMS regulatory compliance
Utilization management
Clinical training
Quality improvement
Bachelor of Science in Nursing
Associate Degree in Nursing

Full Job Description

We are seeking an experienced Registered Nurse (RN) with strong Care Management and/or Utilization Management experience to support clinical training, quality reviews, audits, accreditation, and staff development.

Key Responsibilities

Provide clinical training and education to Care Management/Utilization Management staff.
Conduct clinical and quality reviews of cases.
Educate staff and providers on InterQual/MCG criteria, clinical policies, and procedures.
Develop and update training materials, manuals, and educational resources.
Mentor and support new employees during training and onboarding.
Assist with internal/external audits and accreditation activities.
Support implementation of new programs, systems, processes, and clinical criteria updates.
Analyze performance information and identify training or quality improvement opportunities.
Partner with leadership and subject matter experts on training and process improvements.

Required Qualifications

Current, unrestricted Michigan RN license.
Nursing Diploma or ADN required; BSN preferred.
5+ years healthcare experience.
3+ years Care Management and/or Utilization Management experience.
Experience with InterQual or MCG.
Knowledge of CMS, NCQA, HIPAA, and healthcare regulatory requirements.
Strong clinical assessment, analytical, communication, and training skills.

Preferred

CCM or other Case Management certification.
Health plan/managed care experience.
Clinical training, quality, audit, or accreditation experience.

Technology

Experience with CareAdvance, SharePoint, Excel, Word, Teams, Member Records portals, Virtual Desktop, and working across multiple systems/applications.

Ideal Candidate: An experienced RN who combines Care Management/UM expertise with clinical training, quality review, and staff mentoring experience.

Pay: $37.00 - $39.00 per hour

Benefits:

Dental insurance
Health insurance
Paid time off
Vision insurance

Experience:

Nursing : 5 years (Preferred)
Care Management: 1 year (Required)
Utilization Management: 1 year (Required)
InterQual or MCG: 1 year (Required)

License/Certification:

MI RN License (Required)

Work Location: Remote

Quick Apply

Refine Your Search

utilization review nurse jobs in saint louis, mi

RN Care Management Program Specialist

Psychiatric Care Specialist RN

RN Field Case Manager

Travel Case Management RN

Related jobs to explore

Explore jobs in cities nearby

I want to receive the latest job alert for utilization review nurse in saint louis, mi

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected