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We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams.

YEAR

Wisconsin Physicians Service Insurance Corp

Utilization Management RN

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Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.

Guidehealth

Utilization Management Registered Nurse (RN) - Remote

This is accomplished by providing onsite biometric screenings, engaging participants through technology and programming, educating the participant with risk-specific targeted communications, and supporting positive behavior change through our Health Coaching and Condition Management programs. We are looking for individuals with experience in a medical setting, including but not limited to a receptionist, scheduler, insurance verification, LPN, CNA, Medical Assistants, or individuals with a background in customer service who are looking to make a meaningful impact behind the scenes.

HealthCheck360

Utilization Management Assistant

GreenHouseAPI

Utilization Management CNA

We are looking for individuals with experience in a medical setting, including but not limited to a receptionist, scheduler, insurance verification, LPN, CNA, Medical Assistants, or individuals with a background in customer service who are looking to make a meaningful impact behind the scenes. Our ability to grow as a company, fuels investments in new resources to better serve our clients and provide the amazing career opportunities our employees want and deserve.

Cottingham & Butler

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With Joint Commission Gold Seal accreditation, stroke and heart care awards, CAP-accredited lab and ACS-certified Cancer Center, this flagship facility offers comprehensive services including robotic surgery, cancer care, neurosciences, rehab, emergency/trauma, maternity, behavioral health and a robust nursing excellence program. MercyOne Des Moines Medical Center, founded by the Sisters of Mercy in 1893, is the longest continually operating hospital in Des Moines and Iowa's largest medical center, with 802 beds available.

Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. It is a family of 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, the Trinity Health system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations and many other health and well-being services. In fiscal year 2023, the Livonia, Michigan-based health system invested $1.5 billion in its communities in the form of charity care and other community benefit programs.

Trinity Health

Utilization Review RN

FULL_TIME

OTHER

Technical Skills: Thorough knowledge of policies and procedures, knowledge of managed care principles and methods; medical terminology; proficiency in the application of clinical criteria: InterQual, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, current Procedural Terminology, and Healthcare Common Procedural Coding System, and American Dental codes; working knowledge with medical management systems; proficient with Microsoft Office; knowledge of UM Process; reporting techniques. • Prepares work schedules and monitors staff caseloads to ensure adequate staffing levels at all times and accurate data entry and application of the medical management system.

TriWest Healthcare Alliance

Supervisor, Utilization Management

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Ability to manage crisis calls, apply clinical judgment to assess risk, determine support needs, and coordinate appropriate interventions, including escalation for suicide risk, self-harm concerns, and welfare checks when necessary. Join our Utilization Management team and help ensure members receive timely, appropriate behavioral health services while making a meaningful impact on outcomes.

CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all.

CVS Health Corp

Utilization Management Clinician Behavioral Health Night Shift - 4 Days

Must provide proof of Basic Life Support (BLS Provider-American Heart Association or Professional Rescuer-American Red Cross) prior to employment or within 30 days of hire and maintains current status. Patient outcomes are achieved through effective application of care plans, managed care concepts, appropriateness criteria, resource management, knowledge of community resources, and collaboration with other clinical disciplines.

Case Manager-Utilization Review-RN

Trinity Health Corporation

Case Manager-Utilization Review-Rn

Primary duties may include but are not limited to: Utilizes nursing judgment and reasoning to analyze members' clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. The Medical Management Nurse- AmeriBen is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member's clinical presentation to determine whether to approve requested service(s) as medically necessary.

Elevance Health

Medical Management Nurse - Ameriben

Primary duties may include but are not limited to: Utilizes nursing judgment and reasoning to analyze members’ clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. The Medical Management Nurse - AmeriBen is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member’s clinical presentation to determine whether to approve requested service(s) as medically necessary.

Medical Management Nurse - AmeriBen

Job Overview: This position reports to the Associate Director of Clinical Support and supports the Specimen Management business unit, Pacific Northwest (WI, MN, CO, WA, ID, IA, ND, SD, WY, MN, OR, NE ) This role observes current clinical practice and recommends Best Practice process optimization in all aspects of clinical laboratory and nursing processes. Strong financial and analytical skill and applications to selling tools; Effective communication, and presentation skills; Basic knowledge of Hospital and Laboratory IT (LIS data).

Becton Dickinson and Co

Specimen Management Clinical Specialist RN

Contributes to the development, revision, and implementation of policies, procedures, and guidelines that focus on system performance, network provider and community partner performance, and addressing barriers including health disparity and health related social needs, to improve clinical quality, promote best member and provider experience, and ensure patient safety. Collaborates with all POSC stakeholders and participants to ensure cross-functional collaboration, education and participation in establishing, measuring and evaluating best practice interventions aimed to achieve Quality performance goals.

Quality Management Nurse Consultant

We have a diverse range of employee resource groups (ERGs) to encourage employees with similar interests, goals, social and cultural backgrounds, or experiences to come together for professional and personal development, discussion, activities, and peer support. Coordinates inventory/supply management by reviewing monthly inventory count and approving purchase orders for necessary items to ensure cost containment, timely distribution, and competitive pricing.

Fresenius Medical Care North America is a wholly owned subsidiary of Fresenius Medical Care AG & Co. KGaA, located in Bad Homburg, Germany. Through our dialysis services entity, Fresenius Medical Services, we operate more than 2,100 outpatient dialysis clinics in the U.S. Our Renal Therapies Group is responsible for the manufacture and distribution of a variety of dialysis products and equipment, including dialysis machines, dialyzers and other dialysis-related supplies. 

Fresenius Medical Care

Dialysis Clinical Manager Registered Nurse - RN

The role synthesizes assessment findings to support planning, implementation, and evaluation of care; promotes efficient use of resources; and ensures safe, timely transitions, including patient/family education, follow-up appointments, and linkage to post-acute services. Interdisciplinary Care Coordination & Quality Improvement: Acts as a liaison between the Hospitalist care team, care coordinators, and other members of the patient's health care team (e.g., unit nurses, PT, OT, outpatient providers).

UnityPoint Health

RN Hospitalist-Finley

If you need assistance to navigate Telligen’s careers website or to apply for a position, please send an email to [email protected] We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. Four-year degree in business or health related field and /or equivalent training and/or experience; 3-5 years clinical experience required; Minimum of 5 years’ experience in leadership role or has demonstrated leadership capabilities.

Our Mission: We improve the quality and cost-effectiveness of healthcare for consumers and providers.
 
 Do you deliver healthcare? Or pay for healthcare? No matter your role, Telligen can help you improve quality and lower costs by combining our deep clinical and technical expertise to solve your healthcare challenges. We are passionate about turning raw data into knowledge and knowledge into action, It's what we call "Healthcare Intelligence."
 
 We help you by identifying where and how to drive improvements in members' health. In providers' processes. In how data is leveraged. In how performance is compensated. In how waste is eliminated. And in how resources can be used more efficiently. We have implemented population health management through provider and member engagement and have proven results.
 
 In other words, we help ensure the right care is delivered, in the right setting at the right cost, every time.

Telligen

Supervisor of Health Management

Basic understanding of performance improvement principles, data sampling, data collection, data analysis, and hospitalization procedures and practices related to patient care and utilization of acute care and ambulatory services. Essential Functions: Acquires and maintains the knowledge and skills necessary to retrieve data from hospital information systems including the EHR, Midas, and other databases.

RN -Quality Registered Nurse

The Home Health and Hospice RN is responsible for client care to include direct nursing care, coordination of care, and coordination of services in the home for clients of all ages, unless otherwise specified, in order to assist the client in achieving a maximum level of wellness and independence. Sioux Center Health has been awarded a Top 100 Critical Access Hospital award, Top Workplace honor by The Des Moines Register, and won Best of the Northwest in 13 healthcare categories including Best Place to Work.

Utilization Management Nurse Jobs in Iowa

Utilization Management RN Wisconsin Physicians Service Insurance Corp

Utilization Management Registered Nurse (RN) - Remote Guidehealth

Utilization Management Assistant HealthCheck360

Utilization Management CNA HealthCheck360

Utilization Management Assistant Cottingham & Butler

Utilization Management CNA Cottingham & Butler

Utilization Review RN Trinity Health

Supervisor, Utilization Management TriWest Healthcare Alliance

Utilization Management Clinician Behavioral Health Night Shift - 4 Days CVS Health Corp

Case Manager-Utilization Review-RN Trinity Health

Case Manager-Utilization Review-Rn Trinity Health Corporation

Medical Management Nurse - Ameriben Elevance Health

Medical Management Nurse - AmeriBen Elevance Health

Specimen Management Clinical Specialist RN Becton Dickinson and Co

Quality Management Nurse Consultant CVS Health Corp

Dialysis Clinical Manager Registered Nurse - RN Fresenius Medical Care

RN Hospitalist-Finley UnityPoint Health

Supervisor of Health Management Telligen

RN -Quality Registered Nurse Trinity Health

Registered Nurse (RN) - Home Health Avera Health

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