Manhattan, NY · Remote
This position is ideal for an RN with pediatric clinical experience and a strong background in utilization review, prior authorization, case management, or managed care. Job Duties and ...
Manhattan, NY · Remote
This position is ideal for an RN with pediatric clinical experience and a strong background in utilization review, prior authorization, case management, or managed care. Job Duties and ...
Baton Rouge, LA · On-site
... infant, pediatric, adolescent, young adult, adult and geriatric patients. Incumbent of this ... Communicates as needed with the utilization management physician advisors and/or medical directors ...
Baton Rouge, LA · On-site
... infant, pediatric, adolescent, young adult, adult and geriatric patients. Incumbent of this ... Communicates as needed with the utilization management physician advisors and/or medical directors ...
... for Utilization Management. MINIMUM QUALIFICATION(S): * Bachelor's Degree in Nursing or Master ... Pediatric Trauma Center, and Tertiary Care Provider. As a four-time Magnet-designated hospital ...
... for Utilization Management. MINIMUM QUALIFICATION(S): * Bachelor's Degree in Nursing or Master ... Pediatric Trauma Center, and Tertiary Care Provider. As a four-time Magnet-designated hospital ...
Utilization Management Registered Nurse The Utilization Management Registered Nurse (UM RN) is ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
Utilization Management Registered Nurse The Utilization Management Registered Nurse (UM RN) is ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
Utilization Management Registered Nurse The Utilization Management Registered Nurse (UM RN) is ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
Utilization Management Registered Nurse The Utilization Management Registered Nurse (UM RN) is ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Specialist is responsible for establishing a professional and supportive contact for clients seeking to enter ABA therapy and for current clients receiving ABA services.
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The Utilization Management Specialist is responsible for establishing a professional and supportive contact for clients seeking to enter ABA therapy and for current clients receiving ABA services.
The Utilization Management Specialist is responsible for establishing a professional and supportive contact for clients seeking to enter ABA therapy and for current clients receiving ABA services.
The Utilization Management Specialist is responsible for establishing a professional and supportive contact for clients seeking to enter ABA therapy and for current clients receiving ABA services.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Specialist is responsible for establishing a professional and supportive contact for clients seeking to enter ABA therapy and for current clients receiving ABA services.
The Utilization Management Specialist is responsible for establishing a professional and supportive contact for clients seeking to enter ABA therapy and for current clients receiving ABA services.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... and pediatrics. The nursing team at St. Joseph's University Medical Center, which includes St.
$21.39 - $25.72
2% of jobs
$25.72 - $30.05
9% of jobs
$33.01 is the 25th percentile. Wages below this are outliers.
$30.05 - $34.38
21% of jobs
The median wage is $37.88 / hr.
$34.38 - $38.70
23% of jobs
$38.70 - $43.03
13% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$43.03 - $47.36
10% of jobs
$47.36 - $51.68
8% of jobs
$51.68 - $56.01
5% of jobs
$56.01 - $60.34
5% of jobs
$60.34 - $64.66
2% of jobs
$64.66 - $68.99
2% of jobs
$21
$42
$68
| Aspect | Pediatric Utilization Management | Pediatric Case Management |
|---|---|---|
| Credentials | RN, licensed healthcare professionals, certifications in utilization review | RN, social worker, case management certification |
| Work Environment | Insurance companies, healthcare organizations, utilization review departments | Hospitals, clinics, community health settings |
| Employer & Industry Usage | Insurance providers, managed care organizations | Hospitals, outpatient clinics, social services |
| Focus | Reviewing medical necessity, approving services, optimizing resource use | Coordinating care, supporting patient needs, discharge planning |
While both roles involve working with pediatric patients, Pediatric Utilization Management primarily focuses on reviewing and approving healthcare services for medical necessity within insurance or managed care settings. Pediatric Case Management emphasizes coordinating ongoing patient care and support services across healthcare providers and community resources.
Manhattan, NY • Remote
Other
Posted 27 days ago
Utilization Management RN - Pediatrics (Remote) | New York RN License Required | 110K+
Fully remote opportunity
Pediatric Utilization Management focus
Fast interview process
Location: Remote - Must hold active New York RN license
Job Type: Full-Time
Department: Utilization Management
About Us
Morgan Stephens represents the nation's top healthcare systems, offering highly competitive compensation and benefits to top candidates. We are led by experienced healthcare industry professionals and specialize in contract, contract-to-hire, and direct placement services nationwide.
We have successfully placed thousands of healthcare professionals into organizations seeking high-quality talent and continue to partner with leading health systems and managed care organizations.
Position Summary
The Utilization Management RN - Pediatrics plays a critical role in ensuring pediatric healthcare services are delivered with quality, cost efficiency, and full regulatory compliance. Through clinical review and coordination, this role supports appropriate levels of care, medical necessity determinations, and positive outcomes for pediatric patients and families.
This position is ideal for an RN with pediatric clinical experience and a strong background in utilization review, prior authorization, case management, or managed care.
Job Duties and Responsibilities
Perform concurrent review of pediatric clinical cases for medical necessity and appropriateness of care
Conduct review of prior authorization and precertification requests for pediatric services and treatments
Ensure services align with established clinical guidelines including MCG or InterQual criteria
Collaborate with providers, care teams, and health plan representatives to support coordinated care planning
Monitor utilization trends and identify opportunities to improve quality and cost efficiency
Assist with discharge planning and transition of care coordination for pediatric populations
Advocate for quality patient outcomes and timely access to medically necessary services
Maintain accurate and timely clinical documentation within EMR and utilization management systems
Prepare reports related to utilization activity, case outcomes, and authorization trends
Work independently in a fast-paced remote environment while maintaining productivity and quality standards
Skills and Qualifications
Active, unrestricted Registered Nurse (RN) license in New York required
Minimum of 2+ years of pediatric nursing experience required
Minimum of 2+ years of Utilization Management, Case Management, or Prior Authorization experience preferred
Strong knowledge of MCG or InterQual guidelines
Experience with medical necessity review, concurrent review, and utilization management workflows
Proficiency with EMR systems and Microsoft Office (Excel, Word, Outlook)
Strong communication, critical thinking, and organizational skills
Ability to work independently in a fully remote environment
Preferred Experience
Pediatric managed care or pediatric hospital experience
Medicaid or commercial pediatric population experience
Experience working with children with complex medical needs or chronic conditions
UM or Case Management certification (CCM, ACM) preferred
Why This Role Matters
This role directly supports improved healthcare outcomes for pediatric patients by ensuring medically appropriate, timely, and cost-effective care. You will help families navigate healthcare services while supporting quality-driven clinical decision-making.
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Recruiting and staffing services
11 - 50 Employees
Tallahassee, FL, US
2009
