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Utilization Management Nurse Specialist

Lumen Solutions Group Inc.

Remote • Today

Easy Apply

Contract

Depends on Experience

Applied Behavior Analysis / ABA (Utilization Management)

TalTeam

Remote • Today

Easy Apply

Contract

Depends on Experience

Utilization Review Specialist (Government, RN, LPN)

Elite Technical

Remote • Yesterday

Easy Apply

Contract

40 - 51

Digital Marketing Specialist (Sitecore Content Management)_(Onsite_Need Local_No Relocation_F2F Interview)

Arbor Tek Systems

New York, New York • Today

Easy Apply

Third Party, Contract

Depends on Experience

Red Team Specialist - Vulnerability Management / Manhattan NY / Mesa AZ - Hybrid

Svam International, Inc.

Hybrid in New York, New York • Today

Easy Apply

Contract, Third Party

Up to $70

SAP Transportation Management Specialist

VC5 Consulting

Hybrid in Dallas, Texas • Yesterday

Easy Apply

Full-time

Depends on Experience

Fraud Management Specialist

System One

Hybrid in Almont, Colorado • 13d ago

Easy Apply

Contract

Depends on Experience

Fraud Management Specialist

System One

Hybrid in Merrifield, Virginia • 8d ago

Easy Apply

Contract

Depends on Experience

Journeyman Asset Management Specialist

Govcio LLC

Kearneysville, West Virginia • Today

Full-time

Compensation information provided in the description

Journeyman Asset Management Specialist

GovCIO

No location provided • Today

Full-time

USD 63,000.00 - 81,000.00 per year

Senior Asset Management Specialist

Govcio LLC

Kearneysville, West Virginia • Today

Full-time

Compensation information provided in the description

Senior Asset Management Specialist

GovCIO

No location provided • Today

Full-time

USD 70,000.00 - 90,000.00 per year

HR Portal Content Management Specialist

Gyansys

Hybrid in Austin, Texas • 27d ago

Easy Apply

Contract

Depends on Experience

Change Management specialist @ USA _ Hybrid _ Only on W2

BURGEON IT SERVICES LLC

Hybrid in Texas City, Texas • Yesterday

Easy Apply

Contract

$60 - $70

Change Management Specialist

Hansen Talent Group

Hybrid in Columbia, South Carolina • 7d ago

Easy Apply

Full-time, Third Party

$40.1

Change Management specialist

BURGEON IT SERVICES LLC

Remote • Yesterday

Easy Apply

Contract

Depends on Experience

Construction Management Specialist

InfiCare

Trenton, New Jersey • Yesterday

Easy Apply

Contract, Third Party

Depends on Experience

Data Management Specialist

Bridge Core (BCore)

McLean, Virginia • Today

Full-time

USD 175,000.00 - 195,000.00 per year

Data Management Specialist

DCS Corporation

Ridgecrest, California • 4d ago

Full-time

USD 70,310.00 - 80,000.00 per year

Fraud Management Specialist

Mitchell Martin, Inc.

Merrifield, Virginia • 7d ago

Easy Apply

Third Party, Contract

$42 - $48

Senior Cyber Threat Management Specialist

HTC Global Services

Dearborn, Michigan • Today

Full-time

Lead Specialist Control Room Management

Energy Transfer

Houston, Texas • Today

Full-time

Senior Configuration Management Specialist

DCS Corporation

New York, New York • 4d ago

Full-time

Records Management Specialist 2

ZIO Technologies

Washington, District of Columbia • Today

Easy Apply

Full-time, Contract, Third Party

Product Manager, Specialist

Vanguard Group, Inc.

Malvern, Arkansas • Today

Full-time

Change Management Specialist (OCM) Hybrid Any nearest Infosys Office in the USA

BURGEON IT SERVICES LLC

Hybrid in Dallas, Texas • Yesterday

Easy Apply

Contract

$60 - $70

Waste Management Engineer Specialist/ Waste Acceptance - Oak Ridge, TN

RSI EnTech, LLC

Tennessee Ridge, Tennessee • Today

Full-time

Cyber Threat Management Specialist

Stefanini

Dearborn, Michigan • Today

Easy Apply

Contract

$61 - $66 /hr

Data Management Specialist

Western Alliance Bank

Dallas, Texas • Today

Full-time

Specialist, Rate Management

Vistra Corp

Hybrid in Irving, Texas • Today

Full-time

Depends on Experience

Job Details

Skills

UTILIZATION MANAGEMENT NURSE
UTILIZATION REVIEW NURSE
UTILIZATION MANAGEMENT SPECIALIST
CARE MANAGEMENT NURSE
CASE MANAGEMENT NURSE
CLINICAL REVIEW NURSE
MEDICAL MANAGEMENT NURSE
NURSE CASE MANAGER
PRIOR AUTHORIZATION NURSE
MANAGED CARE NURSE
REGISTERED NURSE
LICENSED PRACTICAL NURSE
UTILIZATION MANAGEMENT
UTILIZATION REVIEW
PRIOR AUTHORIZATION
CARE MANAGEMENT
GUIDINGCARE
GUIDING CARE
FACETS
MCG
MILLIMAN CARE GUIDELINES

UTILIZATION MANAGEMENT NURSE
UTILIZATION REVIEW NURSE
UTILIZATION MANAGEMENT SPECIALIST
CARE MANAGEMENT NURSE
CASE MANAGEMENT NURSE
CLINICAL REVIEW NURSE
MEDICAL MANAGEMENT NURSE
NURSE CASE MANAGER
PRIOR AUTHORIZATION NURSE
MANAGED CARE NURSE
REGISTERED NURSE
LICENSED PRACTICAL NURSE
UTILIZATION MANAGEMENT
UTILIZATION REVIEW
PRIOR AUTHORIZATION
CARE MANAGEMENT
GUIDINGCARE
GUIDING CARE
FACETS
MCG
MILLIMAN CARE GUIDELINES

Summary

Company Description
Lumen Solutions Group Inc. is a technology consulting Services company based in Florida. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, and Enterprise Transformation.

Role: Utilization Management Nurse Specialist
Location: 100% Remote
Duration: 3-Month Contract (Potential for Extension)

Job Description:
We are seeking an experienced Utilization Management Nurse Specialist to support utilization review and care management activities within a managed care environment. The ideal candidate will have a strong clinical nursing background, experience with utilization management processes, and proficiency with industry-standard care management tools and guidelines.

Position Overview

Review medical records and evaluate the medical necessity of healthcare services.
Apply MCG (Milliman Care Guidelines) to make utilization management decisions.
Perform utilization review and care management activities in accordance with payer policies.
Collaborate with physicians, hospitals, and healthcare providers to coordinate patient care.
Document reviews and maintain accurate case information using GuidingCare and Facets.
Manage multiple applications while ensuring timely and accurate case processing.

Required Qualifications

Active RN (preferred) or LPN license with a Maryland or Compact Nursing License.
Minimum 5 years of clinical nursing experience.
Minimum 2 years of Care Management experience.
Previous Utilization Management or Utilization Review experience in a managed care or health insurance environment.
Hands-on experience with:
- MCG (Milliman Care Guidelines)
- GuidingCare
- Facets
Proficient with Microsoft Office and working across multiple systems.

Preferred Qualifications

Critical Care or Emergency Room (ER) nursing experience.
Experience supporting Blue Cross Blue Shield or other health insurance plans.
Previous experience as a Utilization Management Specialist.

Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10483685
Position Id: 26-00681
Posted 2 hours ago

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Remote

•

Yesterday

Utilization Review Specialist (Government, RN, LPN)Introduction:Elite Technical is seeking a Maryland or Nurse Licensure Compact (NLC) certified (RN or LPN) Utilization Review Specialist to support our customer, a major Healthcare payor in the Maryland area. We are seeking candidates who have 5 years of experience as a Nurse, 2 years in a Utilization Management role, and have an understanding of Milliman Care Guidelines (MCG) and Guidingcare/Healthedge. Responsibilities:The Utilization Review Sp

Easy Apply

Contract

40 - 51

Medical Director

Remote

•

2d ago

Medical Director (Utilization Management) - Remote, USLocation: Remote (US) Employment Type: Contract-to-Hire Schedule: Full-time, 40 hours/week <>About the RoleWe are seeking an experienced Medical Director to join a physician-led team responsible for utilization management and clinical review activities for a health insurance organization. This role focuses on evaluating medical necessity, appropriateness of care, appeals, and complex case reviews while ensuring compliance with applicable regu

Easy Apply

Contract

180 - 200

Medical Director

Remote

•

3d ago

Title: Medical Director Shift timings: 8-5 EST M-F Duration: 12 months Location: The role is 100% remote, but candidates need to be from an approved conversion State (Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.) JOB DESCRIPTION The application of a Medical Dir

Easy Apply

Contract

Depends on Experience

Physician ED Claims Reviewer

Remote or Minnesota

•

Today

Required skills: Physician with an active US licensed with experience in with medical coding (CPT/HCPCS) and managed care to conduct clinical review of claims and UM authorization requests for clinical necessity. Minimum of recent (last 2-3 years) 3-5 clinical experience in emergency dept medicine, experience in internal medicine will be considered. Experience in managed care, clinical UM case reviews. Knowledge of claims and medical coding (CPT/HCPCS codes). Proficient working in various syste

Full-time, Contract

USD100000.0/ANNUAL - USD105000.0/ANNUAL