Utilization Management Nurse Jobs in the United States
Luminis Health
$34 - $55
ANNAPOLIS, MD
Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilizes Physician Advisor and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor to resolve payer issues. 2. Denial Management: Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken to avoid denial; assists Care Coordinator in communicating with the patient denied hospital days with work toward resolution and discharge.
Providence Health and Services
$52.26 - $81.13
Kirkland, WA
It is comprised of eight hospital campuses (Ballard, Edmonds, Everett, Centralia, Cherry Hill (Seattle), First Hill (Seattle), Issaquah and Olympia); emergency rooms and specialty centers in Redmond (East King County) and the Mill Creek area in Everett; and Providence Swedish Medical Group, a network of 190+ primary care and specialty care locations throughout the Puget Sound. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Providence Health and Services
$46.3 - $91.32
Olympia, WA
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate admission status based on regulatory and reimbursement requirements of commercial and government payers.
Williamson Health
Murfreesboro, TN
The flagship facility, Williamson Medical Center, which recently opened its new Boyer-Bryan West Tower, offers extensive women's services, state-of-the-art cardiology services, advanced surgical technologies, an award-winning obstetrics and NICU, leading-edge orthopaedics, outpatient imaging services, and distinct comprehensive emergency and inpatient services for both adult and pediatric patients. Timely reviews patients within 24 hours or next business day after admission and at a minimum of every 2 days thereafter for continued stay, applying appropriate criteria (Interqual®) and facilitating reimbursement for services with third payer parties, obtaining and entering authorization number/approval status and notes in Meditech.
Epitec, Inc
Albuquerque, NM
Knowledge, Skills, Abilities Required: • Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member. Essential Duties and Responsibilities: • Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies and compliance guidelines.
Revolution Healthcare Services
$1907
Arcata, CA
You'll work with a dedicated team focused on ensuring appropriate care coordination and resource management, all while living in a region known for its natural beauty, outdoor recreation, and welcoming community atmosphere. This Utilization Review position offers the chance to apply your clinical expertise in a critical healthcare function while enjoying the unique lifestyle of California's scenic North Coast.
Envista Resources
$1310.4 - $1663.2
Arcata, CA
With Envista Healthcare Staffing, your healthcare career is an open ticket to wherever your dreams lead—no limits, no settling, no nonsense. Your dedicated recruiter handles the details, giving you unmatched support every step of the way.
Thrive Staffing
$1549.44 - $1743.5
Arcata, CA
Proof of negative TB screen within the past 12 months. City/State: Arcata, California.
GetMed Staffing
$1646.08
Arcata, CA
Traveling with GetMed Staffing offers the unique opportunity to gain diverse experiences, both personally and professionally. GetMed Staffing is searching for a strong Utilization Review RN to assist our traveler-friendly client.
Mindlance Health
$1863.5
Arcata, CA
Search in Arcata, Eureka, McKinleyville, Blue Lake, Samoa, Fortuna - anywhere within a 30-mile radius of the hospital. Position Start Billing string = Mad River Community Hospital Guaranteed Hours: 36 Contract Weeks:91
Lancesoft Inc
$2300 - $2500
Atlanta, GA
A Utilization Review (UR) RN job involves assessing patient medical records and treatment plans to ensure care is medically necessary, appropriate, efficient, and cost-effective, working with providers and insurers to approve services, manage length of stay, prevent unnecessary procedures, and facilitate smooth transitions, often involving prospective, concurrent, and retrospective reviews. Conduct utilization review of patient cases to ensure quality of care and appropriateness of services provided.
United Health Care Staffing, Inc.
$82
carmichael, CA
Travel Perks: Explore Carmichael, CA Explore the greater Sacramento area during your assignment: stroll or bike the scenic American River Parkway, visit Old Sacramento's historic waterfront and museums, catch a game or event at nearby venues, relax at local parks and coffee shops, or take easy day trips to Folsom Lake and the Sierra foothills for hiking and outdoor adventures. Hashtags #RegisteredNurseJobs #RNCaseManagement #CarmichaelCAJobs #SacramentoHealthcare #NursingJobs #CaseManagerRN #UHCCareers #CernerJobs #HealthcareCareers.
Convergence Medical Staffing
$1997.2
Arcata, CA
The Convergence Medical Staffing Mobile App enables our travelers to search for jobs as well as upload and manage needed information quickly and simply, thus allowing for speedy submittal to facilities. City: Arcata, State: California, Estimated Start , Shift:5 x 8 Hour Day Shift, 07:00:00-15:00:00, 8.00-5, Length of Contract (Days) : 91, Estimated Gross Pay: 0.00.
Adelphi Medical Staffing
$57
Arcata, CA
Previous utilization review or case management experience preferred. Graduate of accredited nursing program (BSN preferred).
GQR Healthcare
$2065
Apple Valley, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2065
Everett, WA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$3652
Juneau, AK
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$1948
Apple Valley, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$1948
Olympia, WA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2446
Oakland, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2122
York, ME
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2585
San Francisco, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2186
Los Angeles, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2509
Tuba City, AZ
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$1642
Knoxville, TN
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$1636
Sonora, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$1695
Baltimore, MD
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2065
Irvine, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$1768
Washington, DC
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$1488
Arcata, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$1636
Clearlake, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2227
Anchorage, AK
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2352
Anchorage, AK
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
Magnet Medical
$2386
Honolulu, HI
The RN in this role works with healthcare providers, insurance companies, and patients to review medical records, treatment plans, and clinical data to determine the appropriate level of care and ensure compliance with healthcare policies and regulations. Work with case management teams to develop appropriate discharge plans, ensuring that the patient is ready for discharge and has the necessary resources and follow-up care.\n.
Magnet Medical
$2406
Orono, ME
Monitoring of Length of Stay and Discharge Planning: Monitor patient length of stay (LOS) to identify potential delays in discharge and ensure that patients are not staying in the hospital longer than necessary. The RN in this role works with healthcare providers, insurance companies, and patients to review medical records, treatment plans, and clinical data to determine the appropriate level of care and ensure compliance with healthcare policies and regulations.
Magnet Medical
$1816.5
Arcata, CA
Monitoring of Length of Stay and Discharge Planning: Monitor patient length of stay (LOS) to identify potential delays in discharge and ensure that patients are not staying in the hospital longer than necessary. The RN in this role works with healthcare providers, insurance companies, and patients to review medical records, treatment plans, and clinical data to determine the appropriate level of care and ensure compliance with healthcare policies and regulations.
Magnet Medical
$2475.59
Camden, ME
Monitoring of Length of Stay and Discharge Planning: Monitor patient length of stay (LOS) to identify potential delays in discharge and ensure that patients are not staying in the hospital longer than necessary. The RN in this role works with healthcare providers, insurance companies, and patients to review medical records, treatment plans, and clinical data to determine the appropriate level of care and ensure compliance with healthcare policies and regulations.
National Staffing Solutions
$1559.25 - $1800.75
Arcata, CA
We`re currently seeking a RN - Utilization Review to join our amazing team with the following qualifications: One or more year(s) of experience as a RN. Licensed to practice as a RN with active license(s) in the state(s) in which employed and practices.
Core Medical Group
$2520
Honolulu, HI
In addition to dedicated, personalized support from your recruiter, when you work with CoreMedical Group you'll receive:Access to an extensive benefits package, including day 1 health, dental, and vision insurance, employer paid life insurance, a health reimbursement account, and more! *Estimate of weekly payments is intended for informational purposes and includes hourly wages, as well as reimbursements for meal & incidental expenses, and housing expenses incurred on behalf of the Company.
JobSquad
$1560 - $2500
Arcata, CA
Flexible payment options; including direct deposit, pay cards, and weekly pay. *Please note this is an estimated range; pay will commensurate with experience.
Lancesoft Inc
$1990 - $2076
Torrance, CA
Facility: Providence SoCal Shared Services Case Management . Position: Registered nurse | Utilization Review .
RadGov, Inc
$2000 - $2328
Apple Valley, CA
About the PositionJoin a Leading Healthcare Client team in Apple Valley, CAfor a rewarding Travel RN Utilization Review contract! Travel RN Utilization Review – Apple Valley, CA | 13 Weeks | Gross $2,328/week.
Specialty Professional Services
$1706.58 - $1796.4
Arcata, CA
Our Client is currently seeking Utilization Review for positions in Arcata, CA for a 5x8 Days shift. The ideal candidate will possess a current CA license or Compact license Depending on the state.
GQR Healthcare
$3539
Los Angeles, CA
We are seeking a Case Manager • RN to join our team, focusing on patient care coordination and management. Join us to enhance patient outcomes through effective case management.
Mindlance Health
$35 - $45
Corpus Christi, TX
Licensed Clinical Social Worker/Registered Nurse License and 2+ years of physical health care management experience, 4-6+ years of physical health care management experience preferred. Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long-term care services!
Mindlance Health
$40 - $45
Rio Grande City, TX
Develops individualized care plans, conducts assessments, ensures service delivery without gaps, and collaborates with providers and caregivers to promote quality and cost-effective healthcare outcomes. Responsible for assessing, coordinating, and managing long-term services and supports (LTSS) for members with complex medical needs.
Mindlance Health
$40 - $45
Charlotte, NC
Develops individualized care plans, conducts assessments, ensures service delivery without gaps, and collaborates with providers and caregivers to promote quality and cost-effective healthcare outcomes. Responsible for assessing, coordinating, and managing long-term services and supports (LTSS) for members with complex medical needs.
Mindlance Health
$40 - $45
Temple, TX
Develops individualized care plans, conducts assessments, ensures service delivery without gaps, and collaborates with providers and caregivers to promote quality and cost-effective healthcare outcomes. Responsible for assessing, coordinating, and managing long-term services and supports (LTSS) for members with complex medical needs.
Mindlance Health
$40 - $45
Fort Myers, FL
Develops individualized care plans, conducts assessments, ensures service delivery without gaps, and collaborates with providers and caregivers to promote quality and cost-effective healthcare outcomes. Responsible for assessing, coordinating, and managing long-term services and supports (LTSS) for members with complex medical needs.
GQR Healthcare
$2065
Orange, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.