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About The Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standar

About The RoleBHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standard

Job Summary/Purpose Conducts utilization reviews to determine if patients are receiving care appropriate to severity of illness or condition and intensity of services required. Monitors patient charts

Integra is looking for a LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key r

The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorization and a

NeueHealth is seeking a full-time Utilization Management Nurse, LVN/LPN, to work from home in California. This role involves ensuring appropriate benefit coverage through prior authorizations. Key res

Date Posted:2026-03-24Country:United States of AmericaLocation:Florida - RemoteWHY JOIN FCSAt Florida Cancer Specialists & Research Institute, we believe our people are our strength and we invest in t

OverviewSite: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers

Utilization Management - Clinical Nurse - Work from Home!Utilization Management - Clinical Nurse - Work from Home!Get AI-powered advice on this job and more exclusive features. Direct message the job

Company Highmark Inc.Job Description JOB SUMMARY This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the

Job Title: Utilization Management RN (Remote) | Baltimore, MD | $85K+Fully remote opportunity. Fast interview process.Location:Baltimore, MD (Remote – must reside in Maryland or hold compact license)J

OverviewPosition SummaryThe Clinical Specialist reports to the Assistant Manager, Medical Management and provides clinical decision-making support and community resource coordination in support of Com

Position Description Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with

Santa Barbara Cottage Hospital is seeking a Clinical Audit Specialist - Utilization Management to conduct audits ensuring compliance with medical necessity criteria. This role requires expertise in ev

OverviewHello Humankindness, Chandler, Arizona, has a stable suburban population with an economy anchored by many large financial and high-tech companies. Located southeast of Phoenix, Chandler is a s

This role will involve up to 40% Travel across AbsoluteCare locationsRN license preferred.Certification in Case Management (CCM), Utilization Review Accreditation Commission (URAC), or related credent

Utilization Management RN - Behavioral Health (OR Licensed)Position Responsibilities SpecificDetermine appropriateness of services through the application and evaluation of medical guidelines, benefit

RemoteJudi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:Capital Rx , a public benefit corporation delivering

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.About The Role You will perform frequent case reviews, check medical records and speak with care providers

Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of m

*Remote and must live in the United States*Job Summary Provides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, executio

Additional Information About the RoleJoin a stable work-from-home team! This is a great opportunity for a local remote position. There is no communication with patients. This position supports all uni

Overview Who We AreBecause health is personal.That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and

Centene Corp. is looking for a Remote Medical Director to direct medical management and enhance quality improvement for our members. You will provide medical leadership and collaborate with clinical t

Join our mission to help transform healthcare delivery from reactive, episodic care to proactively managed patient care that prevents live‑changing problems before they happen for patients with two or