Utilization Management Nurse Jobs in the United States
ChristianaCare
$85862.4 - $137384
Newark, DE
Reviews the admission assessment and collaborates with primary nurse and other health care providers to ensure a multidisciplinary plan-of-care is in place to meet identified patient care needs and desired outcomes. ChristianaCare Hospital in Newark, DE, is seeking a Utilization Management Nurse (RN) with experience with insurance providers such as Aetna and Cigna, along with a background in an acute care hospital.
Providence Health and Services
$57.28 - $88.92
Santa Clarita, CA
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. The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
A-Line Staffing Solutions LLC
$239000 - $259000
San Francisco, CA
This leadership role is responsible for overseeing care coordination, resource utilization, and safe patient transitions across the continuum of care while ensuring compliance, quality, and operational efficiency. Seeking an experienced Nurse Manager II to lead Utilization Management (UM) and Discharge Planning within a 240-bed acute care hospital in San Francisco.
Providence Health and Services
$44.16 - $77.58
Chugiak, AK
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. The goal of the Inpatient Care Management RN is to ensure the use of appropriate healthcare resources throughout the continuum, so that the care provided is the right care, at the right time, in the right setting.
John Muir Health
$89.23 - $121.58
Walnut Creek, CA
See John Muir Health Terms & Conditions at https://www.johnmuirhealth.com/terms-of-use.html and Privacy Policy at https://www.johnmuirhealth.com/content/dam/jmh/Documents/Legal-and-Privacy/website-privacy-policy.pdf and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions. Work shift: 0800-1630Days worked per week: 5Hours worked per day: 8work schedule:Tuesday-Saturday (week 1)Wednesday-Saturday (week 2)Work Shift:
Pyramid Consulting, Inc
$75 - $85
Santa Clara, CA
Utilization Management:-Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge. By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners.
Incredible Health
$59030 - $77630
Macon, GA
Employer features: Academic medical center, Adoption Assistance, Best Places to Work recognition, Career Advance Program, Community hospital, Disability Insurance, Family Care Benefits, FSA, Health Insurance, Level 1 trauma center, Level 2 trauma center, Level 4 trauma center, Life Insurance, Magnet recognized, Medical, Offers sign on bonus, PTO, Retirement Plan, Teaching Hospital, Tuition Assistance, U.S. News best hospital . Hospitals on Incredible Health are actively hiring and accepting applications in the Macon, GA area for the following position: Registered Nurse - Utilization Review.
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.
Kaiser Permanente
Wailuku, HI
Supports high-quality consultation by: communicating with physicians, managers, staff, members, and/or caregivers regarding requirements related to medical necessity and benefit denials across the continuum of care, under direct supervision; and leveraging working knowledge to ensure the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and coverage by members and physicians. In addition to the responsibilities listed below, this position is also responsible for leveraging clinical knowledge of evidence-based guidelines, insurance policies, and clinical criteria to consult on the medical necessity, level of care, and duration of treatment required for basic reviews, and collaborating with the health care team, members, and caregivers to assist in discharge planning, cost of care options, and/or coordinating referrals to appropriate services based on medical necessity.
Providence Health and Services
$43.29 - $76.06
Jber, AK
Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, outreach programs, and hospice and home care. 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
$52.26 - $81.13
Seattle, 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.
GetMed Staffing
$2180.28
Everett, WA
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.
Christus Health
Irving, TX
Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services.
Prime Staffing
$2307.2
Washington, DC
The nurse collaborates with providers, insurance companies, and case managers to ensure compliance with coverage guidelines and supports optimal patient outcomes while managing healthcare costs. Description: The Utilization Review RN is responsible for reviewing medical records to determine the appropriateness and medical necessity of hospital admissions and continued stays.
Memorial Healthcare System
Hollywood, FL
Assists the Case Management staff in resolving patient care issues for referred cases, provides physician education, and assists the hospital and medical staff in developing and promoting resource management goals and objectives. This includes, but not limited to: Makes decisions on referred individual patient cases regarding pre-admission authorization, medical necessity and services/setting, appropriateness of admission, and continuation stay.
Prime Staffing
$2605.2
Orange, CA
The nurse collaborates with providers, insurance companies, and case managers to ensure compliance with coverage guidelines and supports optimal patient outcomes while managing healthcare costs. Description: The Utilization Review RN is responsible for reviewing medical records to determine the appropriateness and medical necessity of hospital admissions and continued stays.
US Tech Solutions, Inc.
$60 - $61
Canton, MA
Key Responsibilities/Duties – what you will be doing Provides all aspects of clinical decision making and support needed to perform utilization management, medical necessity determinations and benefit determinations using applicable coverage documents, purchased clinical guidelines or Medical Necessity Guidelines for clinically complex services / coverage requests in a consistent manner and within established, product specific time frames. Interfaces between Precertification staff and providers when issues arise regarding policy interpretation, potential access availability or other quality assurance issues to ensure that members receive coverage decisions timely within all accrediting and regulatory guidelines.
GQR Healthcare
$1315 - $1410
Windom, MN
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
$2662 - $2757
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
$2557 - $2652
Burlingame, 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
$1860 - $1955
Alamogordo, NM
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 - $2447
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
$2065 - $2160
Seattle, 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
$2007 - $2102
Detroit, MI
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
$2511 - $2606
Falls Church, VA
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
$2150 - $2245
Portland, OR
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
Sundance, WY
Role Overview - RN responsible for case management across acute care, swing bed, and outpatient services. Focus on discharge planning, utilization review, care coordination, and CMS compliance.
GQR Healthcare
$1768 - $1863
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
$2110 - $2205
Santa Barbara, 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
$2500 - $2595
Falls Church, VA
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.
National Staffing Solutions
$1826.55 - $2109.45
Kinston, NC
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.
TechLink Systems, Inc.
Everett, WA
Guaranteed Hours: 72 hours per 2 week period. Total Weekly Hours: 40 Start date: ASAP.
Mohawk Valley Health System
$40.19 - $50.61
UTICA, NY
Core Job ResponsibilitiesCoordinates discharge planning to assure that the patient progresses through the continuum of care and is discharged to the least restrictive environment. Bachelors or Masters Degree in related healthcare field (such as respiratory therapy or social work) may be considered.
Providence Health and Services
Oak Grove, OR
Works with the Regional Director CM, PHSOR leaders, clinical professionals, health plans and Coordinated Care Organizations, and community and government agencies as appropriate to establish effective discharge planning mechanisms and develop new models for transitioning patients back into home and community settings. See Providence Health and Services Terms & Conditions at https://www.providence.org/utility-pages/privacy-policy#terms-of-use and Privacy Policy at https://www.providence.org/utility-pages/privacy-policy#privacy-policy and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.
Incredible Health
$48920 - $94690
Memphis, TN
Nurses with experience in any of the following areas are strongly encouraged to apply: Assistant Nurse Manager, CNO, Charge, Clinical Nurse Coordinator, Clinical pathway, Director, Manager, Navigator, Supervisor, Utilization Review, or VP. Hospitals on Incredible Health are actively hiring and accepting applications in the Memphis, TN area for the following position: Nurse Manager - Case Management.
BoldAge PACE
Evansville, IN
Pass a comprehensive criminal background check that may include, but is not limited to, federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen. . Provide coordination and direct care as indicated to promote continued care in the community or promote optimal institutional care (Assisted Living, Nursing Home, Hospital, etc.) as needed.
Convergence Medical Staffing
$2286
Kinston, NC
Job Nurse - Utilization Review @ UNC Health Lenoir, City: Kinston, State: North Carolina, 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. 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.
Job.com LLC
$2900 - $3000
Greenbrae, CA
We are seeking an experienced Registered Nurse (RN) – Utilization Review to join our healthcare team in an acute care hospital setting. Collaborate with physicians, case managers, and healthcare teams to optimize patient outcomes.
Mindlance Health
$40 - $45
Goldsboro, 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.
GQR Healthcare
$1931 - $2026
Greensboro, NC
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.
Endeavor Health
$40.45 - $62.7
Glenview, IL
Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. Provides and/or arranges clinical education including medication management, community resources, financial resources, and expert guidance to patients and families to promote their ability to understand and meaningfully participate in the healthcare process and personal decision-making.
GQR Healthcare
$1357
Brownsville, TX
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
GQR Healthcare
$1524
Tallahassee, FL
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
GQR Healthcare
$1357
Round Rock, TX
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
GQR Healthcare
$1740
Fort Wayne, IN
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
GQR Healthcare
$1693
Asheville, NC
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
GQR Healthcare
$2088
Oklahoma City, OK
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: 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.
Lancesoft Inc
$2230
Apple Valley, CA
Years of experience REQ: 3-year acute medical Care Manager/UM experience performing utilization review in a hospital setting (not health plan/medical group). • First-timers accepted: Seasoned traveler is required Hardstop.