As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
Quick apply
60 Ucare Utilization Management Nurse Jobs Hiring Near You
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
Utilization Management Nurse
$80K - $95K/yr
Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This individual ...
Utilization Management Nurse
$80K - $95K/yr
Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This individual ...
Utilization Management Nurse The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost ...
New
Utilization Management Nurse The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost ...
New
Lead Utilization Management Nurse
Oak Brook, IL · On-site +1
We have an innovative organization looking to add a Lead Utilization Management Nurse to its team. Their main purpose is to enable physicians to engage, support, and manage new value-based savings ...
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Lead Utilization Management Nurse
Oak Brook, IL · On-site +1
We have an innovative organization looking to add a Lead Utilization Management Nurse to its team. Their main purpose is to enable physicians to engage, support, and manage new value-based savings ...
Utilization Management Nurse
$60 - $75/hr
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
Quick apply
Utilization Management Nurse
$60 - $75/hr
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
Utilization Management Nurse
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
Utilization Management Nurse
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
Utilization Management Nurse
$74.16 - $107.75/hr
Description The Utilization Management (UM) Nurse supports appropriate levelofcare determination, patient flow, and revenue cycle integrity across inpatient, partial hospitalization, and intensive ...
Utilization Management Nurse
$74.16 - $107.75/hr
Description The Utilization Management (UM) Nurse supports appropriate levelofcare determination, patient flow, and revenue cycle integrity across inpatient, partial hospitalization, and intensive ...
Utilization Management Nurse
Los Angeles, CA · On-site
$60 - $75/hr
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
Utilization Management Nurse
Los Angeles, CA · On-site
$60 - $75/hr
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we ...
Utilization Management Nurse
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
Utilization Management Nurse
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
The Utilization Management Nurse (RN or LPN) is responsible for coordinating, monitoring, evaluating, and managing utilization review activities and authorization requests for members with complex ...
The Utilization Management Nurse (RN or LPN) is responsible for coordinating, monitoring, evaluating, and managing utilization review activities and authorization requests for members with complex ...
Utilization Management Nurse
Los Angeles, CA · On-site
$74.16 - $107.75/hr
The UM Nurse functions in two utilization management roles for coverage purposes utilization review/payor authorization and patient placement-ensuring continuity of operations, timely access to care ...
Utilization Management Nurse
Los Angeles, CA · On-site
$74.16 - $107.75/hr
The UM Nurse functions in two utilization management roles for coverage purposes utilization review/payor authorization and patient placement-ensuring continuity of operations, timely access to care ...
Utilization Management Nurse
Doral, FL · On-site
The Utilization Management Nurse (RN or LPN) is responsible for coordinating, monitoring, evaluating, and managing utilization review activities and authorization requests for members with complex ...
Utilization Management Nurse
Doral, FL · On-site
The Utilization Management Nurse (RN or LPN) is responsible for coordinating, monitoring, evaluating, and managing utilization review activities and authorization requests for members with complex ...
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
Utilization Management Nurse
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
Utilization Management Nurse
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
Utilization Management Nurse
$75K - $85K/yr
Summary The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost-effective care. The ...
Utilization Management Nurse
$75K - $85K/yr
Summary The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost-effective care. The ...
Utilization Management Nurse
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
Quick apply
Utilization Management Nurse
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse ...
The Utilization Management Nurse (RN or LPN) is responsible for coordinating, monitoring, evaluating, and managing utilization review activities and authorization requests for members with complex ...
The Utilization Management Nurse (RN or LPN) is responsible for coordinating, monitoring, evaluating, and managing utilization review activities and authorization requests for members with complex ...
Summary The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost-effective care. The ...
Summary The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost-effective care. The ...
UCare Jobs Information
What are the key skills and qualifications needed to thrive as a Utilization Management Nurse, and why are they important?
To thrive as a Utilization Management Nurse, you need a registered nursing license, strong clinical judgment, and experience in case management or utilization review. Familiarity with medical management software, InterQual or Milliman guidelines, and insurance authorization processes is typically required. Excellent analytical thinking, communication, and negotiation skills help you coordinate with providers and advocate for patients. These competencies ensure appropriate resource use, compliance with regulations, and optimal patient outcomes.
What are some common challenges a Utilization Management Nurse faces when coordinating care between providers and insurance companies?
A Utilization Management Nurse often navigates the challenge of balancing patient advocacy with insurance guidelines, ensuring that care recommendations meet both clinical standards and payer requirements. Communicating complex medical information to both providers and insurance representatives can be demanding, especially when there are disagreements about coverage or medical necessity. Additionally, staying updated on changing policies and maintaining thorough documentation under tight deadlines are frequent aspects of the role. Strong collaboration skills and attention to detail are essential for success in this position.
What is a Utilization Management Nurse?
A Utilization Management Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients. They review medical records and treatment plans to ensure that care meets established guidelines and is cost-effective. Utilization Management Nurses work with healthcare providers, insurance companies, and patients to coordinate care and prevent unnecessary procedures or hospitalizations. Their goal is to support high-quality patient care while managing healthcare costs.
What is the difference between Utilization Management Nurse vs Case Manager?
| Aspect | Utilization Management Nurse | Case Manager |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, case management certification often preferred |
| Work Environment | Insurance companies, healthcare organizations, utilization review departments | Hospitals, community health agencies, insurance companies |
| Primary Focus | Reviewing medical necessity and appropriateness of services | Coordinating patient care and discharge planning |
Utilization Management Nurses primarily focus on reviewing medical necessity and approving healthcare services, while Case Managers coordinate patient care and facilitate discharge planning. Both roles require RN licensure and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.
What other companies are hiring for Utilization Management Nurse jobs?
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 10 days ago
Job description
Benefits:
Benefits/Perks
We are seeking a Utilization Management Nurse to join our team! As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we are running at optimal efficiency, and that all patients under our care are receiving the necessary treatments and procedures. The ideal candidate has deep experience in a similar medical setting, has a bachelor's or higher in Nursing, and has a certification in either Case Management or Utilization Management.
Responsibilities
- Employee discounts
- Paid time off
- 401(k) matching
- Competitive salary
- Dental insurance
- Health insurance
- Training & development
- Vision insurance
- Wellness resources
Benefits/Perks
- Competitive Compensation
- Great Work Environment
- Career Advancement Opportunities
We are seeking a Utilization Management Nurse to join our team! As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we are running at optimal efficiency, and that all patients under our care are receiving the necessary treatments and procedures. The ideal candidate has deep experience in a similar medical setting, has a bachelor's or higher in Nursing, and has a certification in either Case Management or Utilization Management.
Responsibilities
- Review patient files and treatment information for efficiency
- Monitor the activity of staff to ensure effective patient treatment
- Advocate for quality patient care to prevent complications
- Review discharge information for outgoing patients
- Work closely with clinical staff to provide excellent patient care
- Prepare reports on patient management and cost assessments
- Nurse, with state LPN licensure, required
- Certificate in Case Management or Utilization Management desired
- Strong communication and interpersonal skills
- Strong analytical skills