Top 7 Utilization management nurse Jobs in Stanton, Tn

Remote Utilization Review RN or LVN (Inpatient/SNF Team.) Must have CA license.
Dragonfly Global —United States
- $48.00 - $50.48 an hour
- Full-time
- Remote
- Spanish
- Nursing
- Microsoft Excel
- Paid holidays
- Disability insurance
Quick Apply
Regional Director of Utilization Management
ADDICTION AND MENTAL HEALTH SERVICES, LLC —United States
- $115,000 - $130,000 a year
- Full-time
- Nursing
- 3 years
- Master's degree
- Loan repayment program
- Health insurance
9d

Other jobs to consider

Find your next job by exploring related positions.

RN-Utilization Review PRN
Baptist Memorial Health Care —Memphis, TN
RN with at least one (1) year of clinical experience. RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting.
Nurse Practitioner or Physician Assistant Long Term Care Weekends Blytheville, AR Area
ACCESS MEDICAL CLINIC —Blytheville, AR
Must maintain an active license in good standing throughout employment. Practice with strong independent clinical judgment within scope of licensure.
Quick Apply
6d

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Care Manager - Part Time - University Hospital
The Ohio State University Wexner Medical Center —Columbus, OH
This position maintains awareness of emerging state and national healthcare trends and drives initiatives to enhance care quality and ensure effective resource…
6d
Manager, Behavioral Health Clinical Liaison/Operations
Amerihealth Caritas —Dublin, OH
Independent, current, and unrestricted Ohio license required, including one of the following: Represent the plan to external stakeholders, including state…

Show more jobs in cities nearby

I want to receive the latest job alert for utilization management nurse in stanton, tn

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 management nurse jobs near stanton, tn

Regional Director jobs in Hurst, TX

Regional Director jobs in Dallas Fort Worth, TX

Project Director jobs in Remote

Regional Director jobs in Arroyo Grande, CA

Regional Director jobs in Temple, TX

Utilization Review Nurse jobs in Morristown, NJ

Utilization Review Nurse jobs in Springfield, MA

Document Review jobs in Minneapolis, MN

Utilization Review Nurse jobs in Durham, NC

Utilization Review Nurse jobs in Tulsa, OK

Utilization Management Remote jobs in Michigan

Nurse Practitioner jobs in Omaha, NE

Remote Utilization Review RN or LVN (Inpatient/SNF Team.) Must have CA license.

Dragonfly Global
United States

Quick Apply

Job Details

Full-time | Contract
$48.00 - $50.48 an hour

Benefits

Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Life insurance
Retirement plan

Qualifications

Microsoft Excel
Inpatient experience
Medicare
Utilization review
RN License
CMS
CMS regulatory compliance
Medicare regulations
Concurrent review in utilization management
Associate's degree
Associate Degree in Nursing

Full Job Description

Job Type: Full-time, Contract to Permanent Hire.
Schedule: Monday - Friday

8:00 AM – 5:00 PM PST (Must be able to work Pacific hours)
Location: Remote (California license required - CA is NOT a compact state))

Job Summary
We’re seeking an experienced Utilization Management Nurse (RN or LVN) to support inpatient review and care coordination for patients requiring ongoing medical oversight. We are looking for someone strong in Post Acute, such as SNF, LTAC, etc. This role is designed for nurses who want to make an impact by ensuring patients receive safe, appropriate, and cost-effective care. You’ll partner with physicians, hospital staff, and case managers to coordinate treatment plans and transitions of care.

This position is remote, though an active California nursing license is required. California is NOT a compact state.

Responsibilities

Perform inpatient concurrent reviews and assess admissions/continued stays using MCG (Milliman Care Guidelines).
Provide oversight for patients with complex or chronic conditions, identifying those who may require post-discharge case management.
Communicate with physicians, case managers, and discharge planners to coordinate patient care plans.
Participate in interdisciplinary team meetings and patient rounds.
Accurately document clinical activities and case updates in the care management system.
Track case progress and provide updates to UM leadership.
Monitor for overutilization or underutilization patterns and escalate concerns when needed.

Qualifications

Required:

Current, unrestricted California RN or LVN license.
At least 2 years of inpatient review, or utilization management experience.
Post Acute experience; SNF/LTACH/Rehab, etc.
Familiarity with evidence-based criteria such as Milliman Care Guidelines (MCG) and CMS Guidelines.

Preferred (not required):

3+ years of nursing experience in a managed care setting.
IPA or Health Plan experience
Background in Medicare Managed Care.
Experience with utilizing clinical criteria such as Milliman, InterQual, CMS National and Local Coverage Determinations (LCD).
Associates or Bachelor’s degree in Nursing.
Strong critical thinking and problem-solving skills.
Excellent communication and interpersonal abilities.
Comfortable working in a fast-paced environment with multiple priorities.
Proficiency in Microsoft Word, Excel, and Outlook.

What We Offer

Remote position – work from home with a California license.
Competitive compensation (range dependent on location and experience).
Comprehensive benefits package, including:
Medical, dental, and vision insurance.
401(k) retirement plan with employer contributions.
Paid time off, personal days, and holidays.
Life insurance and disability coverage.
Ongoing training and career development opportunities.

Pay: $48.00 - $50.48 per hour

Benefits:

401(k)
Dental insurance
Health insurance
Retirement plan
Vision insurance

Application Question(s):

Are you able to work 8am - 5pm PACIFIC STANDARD hours?
We are looking for someoen string in Post Acute/SNF - Have you independently performed inpatient reviews for post-acute placements such as SNF, LTACH, or inpatient rehab?

Experience:

Concurrent Review: 1 year (Required)
Medicare Advantage : 1 year (Required)
CMS guidelines: 1 year (Required)
Utilization Review : 1 year (Required)

Language:

fluent Spanish (Preferred)

License/Certification:

CALIFORNIA RN or LVN license (CA in NOT a compact state) (Required)

Work Location: Remote

Quick Apply

Refine Your Search

utilization management nurse jobs in stanton, tn

Remote Utilization Review RN or LVN (Inpatient/SNF Team.) Must have CA license.

Regional Director of Utilization Management

Other jobs to consider

Explore jobs in cities nearby

I want to receive the latest job alert for utilization management nurse in stanton, tn

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected