UNKNOWN

ADAPTED_NOW

The primary responsibility of the MDS Nurse is to organize, complete and evaluate resident assessment and plan of care in accordance with current applicable state, federal guidelines/ regulations and as may be directed by the Director of Nursing to ensure each resident is encouraged to attain the highest possible level of functioning. The ability to anticipate needs of residents/clients and co-workers in a pro-active fashion seeking to meet those needs even before a formal request is made.

HOUR

Franciscan Ministries

MDS Registered Nurse (RN) - PRN

Easy Hiring FTP

FEED

Consistently recognized for clinical excellence, Mercy Fitzgerald is proud of our many quality achievements such as: Blue Distinction Center for Cardiac Care, Bariatric Surgery Center of Excellence, Achievement Awards from the American Heart/Stroke Associations and Certified Primary Stroke Center. Ministry/Facility Information: Trinity Health Mid-Atlantic was formed in October 2018 and is the largest Catholic healthcare system serving the Greater Philadelphia area and is a part of Trinity Health of Livonia, Michigan, and sponsored by Catholic Health Ministries.

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

Registered Nurse Care Manager - Utilization Management

Reviews are to include current medical status with supporting labs, study results and treatments which are relevant to the level and acuity of care, procedures, surgeries, plan of care and patient progress towards goal, provide any contributing social, educational or discharge planning issues. Essential Duties and Responsibilities: Determines medical necessity, appropriateness of admission, continuing stay and level of care using a combination of clinical information, clinical criteria, and third-party information.

YEAR

Children's Hospital of Philadelphia

Utilization Management Nurse

IRecruitee

BLS - Basic Life Support or BLS-I - Basic Life Support - Instructor or ARC-BLS - Amer Red Cross Basic Life Support or BLS-I-P - Basic Life Support Instructor-Provisional (180 Days) within 90 Days. Key On-Site Responsibilities Physician and Clinical Collaboration o Physician Consultation: Meet in person with attending/admitting providers to discuss cases where documentation does not support medical necessity or the current level of care.

Wellstar

RN Utilization Management - FT/DAY - WMCG

Registered Nurse (RN) - Utilization Management – FT/Day - Augusta

Ensures timely and accurate documentation of clinical reviews and insurance updates as required by payor including authorized days and denied days with reason for denial * Works post-discharge/prebill accounts efficiently and effectively daily, to resolve accounts with no auth numbers, ALOS vs. The Utilization Management (UM) Nurse is responsible for conducting medical necessity reviews up to 12 hours per day, on any of the 7 days per week, utilizing Indicia for Case Management, and performs clinical reviews through document review, discussion with physicians and collaboration with the care team on the coordination of safe transitions of care for a defined patient population.

Registered Nurse (RN) - Utilization Management - PRN - North Fulton

Builds and fosters collaborative relationships with other departments/service-lines within the organization to stay informed and abreast of new initiatives, products, and services; identifies opportunities to support organizational initiatives, quality, efficiency, effectiveness and world class service excellence. Consistently recognized for world-class care, Tampa General Hospital is ranked as the #1 hospital in Tampa Bay by U.S. News & World Report for 2025-26 and is nationally ranked among the top 50 hospitals in the nation in six specialties.

Tampa General Hospital

Registered Nurse (RN) - Manager, Wound Care - $90K per year

One Red Cent - Marketplace

Serves as OB Dept Dayshift Charge RN on other duty days and partners with clinical resource nurses to support operations which include weekends and holidays; •Performs all duties listed in the RN job descriptions for labor and delivery, postpartum, and special care nursery. TalentBurst Health & Life Sciences is an established provider of healthcare workforce solutions, servicing healthcare facilities across the United States for over 15 years.

WEEK

For over 20 years, TalentBurst Inc. has been an award-winning provider of cutting-edge Workforce Management Solutions. With a strong commitment to staying ahead in the tech landscape, we pioneer innovative approaches to talent acquisition. Our expertise spans Life Sciences, and Healthcare Staffing, Banking, Financial, IT, and Engineering, as well as Global Employer of Record (EOR), Agent of Record (AOR), State, Local Government and Education (SLED), and IC validation/compliance services. Additionally, our division, TalentProcure, leads the industry with offerings such as High Hazard Payroll, Managed Services, and Vendor on Premise (VOP) solutions.
Due to our prioritization of excellent standards, we are Joint Commission Certified and are a certified Minority Business Enterprise (MBE) in the USA and Canada. Supporting over 130 Fortune 500 companies globally, we excel in navigating the landscape of talent acquisition. In a world of constant change, we embrace developing people-centric solutions that address the unique demands of our clients. Stay connected by visiting our website and following us on social media!

TalentBurst, Inc

Travel Mother/Baby Nurse Manager - $4,008 per week

FULL_TIME

We foster a culture built on teamwork, excellence, accountability, respect, customer service, and enthusiasm, where every employee plays an important role in delivering patient-centered care and making a difference in our community. We foster a culture built on teamwork, excellence, accountability, respect, customer service, and enthusiasm, where every employee plays an important role in delivering patient-centered care and making a difference in our community.

Covenant HealthCare

RN CLINICAL MANAGER - UTILIZATION MANAGEMENT (UM)

[AW]-iCims

Complete assessments and plans of care including need for medication regime, treatment plans, practitioner follow-up appointments, knowledge of red flags, disease management, Advance Directives, life planning, and self-management of illness to the best of member ability. Refer all members with complex health problems and needs to Network Health Case Management to reduce medical costs while providing a higher quality of life and an ability to take charge of their diseases.

Network Health LLC

RN Coordinator Utilization Management

A compact nursing license allows registered nurses to work in any state that is part of the Nurse Licensure Compact without needing separate state licenses. Were seeking leaders who have a Case/Utilization Management background and are immediately available to fill Interim roles with healthcare organizations across the country.

B. E. Smith, Inc.

Interim Case/Utilization Management Nurse Leaders

PRIMARY PURPOSE: To support utilization management, quality improvement, population health, and performance improvement activities within FoundCare, promoting high-quality, patient-centered, cost-effective care while ensuring compliance with HRSA, UDS, CMS, value-based care, and payer requirements. Clear understanding that FoundCare provides information on educating individuals on safer sex practices which would include but not be limited to, exposure to explicit language, explicit printed material, and descriptions of explicit sexual activities as part of the agency's mission in the prevention and transmission of HIV disease.

FoundCare

Utilization And Quality Nurse

ea_via_bold

PART_TIME

Network Health, Inc

Weekend RN Coordinator Utilization Management (1.0 FTE)

In this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. We are seeking nurses with at least one year of outpatient UM experience in a fast-paced setting.

Astrana Health Inc

UM Review Nurse - LVN

Skills: Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding 4. Experience in utilization management and/or medical review preferred. Communication: Collaborates with healthcare providers and internal staff to promote quality of care, cost effectiveness, accessibility and appropriateness of service levels.

GEE Group, Inc

jobdiva

OTHER

Perform retrospective utilization reviews and first level determination approvals for members using evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare and FEP. Also, you will be reviewing hospital itemized bills for a comprehensive line-by-line audit and manual claims processing on exceptions to ensure that appropriate billing practices are followed based on facility specific contract language.

Pacer Group

Senior Utilization Management Nurse

Ceipal

Presidential Staffing Solutions

The combined efforts of the organization's outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation's "100 Best Places to Work in Health Care". The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria, regulatory requirements, and organizational role.

St. Joseph's Healthcare System

Nurse Registered Utilization Management

Utilization Management Registered Nurse

For Inpatient RNs, performs unit based inpatient case management duties, with the ability to perform RN case management assessments, discharge planning, formulating safe plans of care and anticipating patient care needs. The incumbent consistently communicates and treats the Veteran and as appropriate the Veteran’s family, caregiver and/or significant other, the Veteran representatives, visitors to VA facilities, all VA staff, and other customers in a courteous, tactful, and respectful manner.

Utilization Review Nurse Jobs in the United States

MDS Registered Nurse (RN) - PRN Franciscan Ministries

Registered Nurse Care Manager - Utilization Management Trinity Health

Utilization Management Nurse Children's Hospital of Philadelphia

RN Utilization Management - FT/DAY - WMCG Wellstar

Registered Nurse (RN) - Utilization Management – FT/Day - Augusta Wellstar

Registered Nurse (RN) - Utilization Management - PRN - North Fulton Wellstar

Registered Nurse (RN) - Manager, Wound Care - $90K per year Tampa General Hospital

Travel Mother/Baby Nurse Manager - $4,008 per week TalentBurst, Inc

RN CLINICAL MANAGER - UTILIZATION MANAGEMENT (UM) Covenant HealthCare

RN Coordinator Utilization Management Network Health LLC

Interim Case/Utilization Management Nurse Leaders B. E. Smith, Inc.

Utilization And Quality Nurse FoundCare

Weekend RN Coordinator Utilization Management (1.0 FTE) Network Health, Inc

UM Review Nurse - LVN Astrana Health Inc

Utilization Management Nurse GEE Group, Inc

Senior Utilization Management Nurse Pacer Group

Utilization Management Nurse Presidential Staffing Solutions

Nurse Registered Utilization Management St. Joseph's Healthcare System

Utilization Management Registered Nurse St. Joseph's Healthcare System

Utilization Management Nurse Presidential Staffing Solutions, LLC

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