Jobs in the United States

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Added 2 mins ago
SI
Summer 2027 Intern - Sales Immersion, Financial Services
Salesforce, Inc.
NY
- $30 to $32 USD / hour
Our Futureforce University Recruiting program is dedicated to attracting, retaining and cultivating talent. Our interns and new graduates work on real projects that affect how our business…
Added 2 mins ago
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2027 Summer Internship - Kaufman Hall Marketing Team
Vizient
Chicago
- $25 USD / hour
This program is designed to foster a beneficial relationship and provide growth opportunities for Vizient, our employees, and collegiate students. Since 2000, our summer intern program has…
Added 3 mins ago
Project Analyst
OSC Global
Remote, United States
Follow DevSecOps, software development, release management, change management, quality assurance, and production support processes and procedures.
Added 4 mins ago
Principal Technical Advisor, Country Backstop
Johns Hopkins University
Washington
…technical leadership for M&E and PBF planning during workplan development, monitors project performance, reviews and analyzes data to support evidence-based decision-making, and contributes…
Added 4 mins ago
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Sales Operations Coordinator
Precoa
Portland, OR
- $45,000 to $60,000 USD / year
Support the day-to-day work of the Sales Operations team and build strong relationships across Field Management, Marketing, Sales Development, and the Data Team. You’ll become the person…
Added 6 mins ago
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Senior Technical Program Manager - AV Engineering
Wayve
Sunnyvale, CA
- $171,600 to $229,300 USD / year
Wayve’s Program Management team turns complex technical goals into coordinated delivery. Working closely with engineering, research, product, safety, evaluation and release teams, we align…
Added 9 mins ago
Early Childhood Learning Coordinator
Safe Passages
Oakland, CA
…continuum of services that support student success and community development. Safe Passages serves over 8,000+ children and families annually through our strategies that span the age…
Added 10 mins ago
Director Facilities Management
Medxcel
Jacksonville, FL
Schedule: Day shift | Full-time
Added 10 mins ago
Maintenance Mechanic II
Medxcel
Nashville (Midtown), TN
Schedule: Day shift | Full-time · Must have one or more of the following:
Added 10 mins ago
HC
Diversion & Groups Services Manager
Harris County
Houston, TX
- $78,832 to $88,691.2 USD / year
Must have four (4) years of verifiable, full-time paid experience in a supervisory role in a Social Services setting
Added 10 mins ago
HC
Library Specialist (HCPL @ MAM Branch Library)
Harris County
Houston, TX
- $20 USD / hour
…Enhanced+ Library Cards, and its Mobile Outreach Librarian…
Added 10 mins ago
Mail and Delivery Clerk
Harris County
Houston, TX
Utilize good time management skills and effectively prioritize and schedule multiple tasks/initiatives.
Added 10 mins ago
Office Support Clerk
Harris County
Houston, TX
Utilize good time management skills and effectively prioritize and schedule multiple tasks/initiatives.
Added 10 mins ago
Receptionist
Harris County
Houston, TX
Must have a professional attitude and appearance
Added 10 mins ago
HC
Watershed Coordinator
Harris County
Houston, TX
- $66.81 to $100.21 USD / hour
…review and approval process of government and private sector development plans and plats for the Watershed Management Department to ensure compliance with the District’s design criteria,…
Added 10 mins ago
HC
CHS Mobile Program Manager
Harris County
Houston, TX
- $21 USD / hour
The Clinical Health Services (CHS) Mobile Program Manager will support both clinical and non-clinical services through management of personnel, grant fiscal management, and mobile…
Added 11 mins ago
General Manager(03109) - 10052 Cross Creek Blvd
Domino's
Tampa, FL
…Assistant Managers to be trained and certified through our unique Management Development Program. If you have limited experience, this program will teach you everything you need to learn to…
Added 11 mins ago
American Sign Language Interpreter
TheraPeds
Shawnee, KS
…services while making meaningful connections in a collaborative learning…
Added 11 mins ago
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Physical Therapist
TheraPeds
Menlo Park, CA
- $65 to $75 USD / hour
…services while making meaningful connections in a collaborative learning…
Added 11 mins ago
School Psychologist
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Greenwood Village, CO
…services while making meaningful connections in a collaborative learning…
Added 11 mins ago
Speech Language Pathologist
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Green Valley Ranch, CO
…services while making meaningful connections in a collaborative learning…
Added 11 mins ago
Speech Language Pathologist
TheraPeds
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…services while making meaningful connections in a collaborative learning…
Added 11 mins ago
Staff Software Engineer - DevOps
Northrop Grumman
San Diego · Melbourne · El Segundo
Must have experience with developing software using agile processes (Kanban, Scrum, Scrumban) · Must have experience with one of the following change management tracking system tools: Jira, ClearQuest, Asana
Added 11 mins ago
General Manager(09460) - 17792 Aprile Dr.
Domino's
Land O' Lakes, FL
…Assistant Managers to be trained and certified through our unique Management Development Program. If you have limited experience, this program will teach you everything you need to learn to…
Added 11 mins ago
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Speech Language Pathologist Assistant
TheraPeds
Sheridan, CO
- $55 to $65 USD / hour
…services while building meaningful connections in a collaborative learning…

Personify Health

Utilization Management Nurse RN

United States

$35 to $38 USD / hour

Apply on careers-personifyhealth.icims.com About employer

Applications open in a new tab.

Job details

Pay: $35 to $38 USD / hour
Apply by: Nov 13, 2027
Experience: Minimum 1–2 years of recent clinical experience in acute care, med-surg, ICU/ED, or another relevant setting
Posting language: English
Posted: Nov 13, 2026

Original job description

Overview

Who We Are

Because health is personal. That's why Personify Health created the first and only personalized health platform - bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.

Learn even more about the work that drives us at personifyhealth.com.

Responsibilities

Ready to make the right call on care, fast, fairly, and by the book?

Why This Role Matters

Every day, members and providers are waiting on a decision that shapes what care happens next. As a Utilization Management Nurse, you’re the clinical expert who gets it right. You’ll review requests against plan language, medical policies, and evidence-based criteria, then deliver timely, compliant determinations that protect both member access and appropriate use of resources. When a case needs a deeper look, you’ll route it to the Medical Director and support appeals with clear, complete clinical summaries. Your documentation keeps us audit-ready under NCQA and URAC standards. When you deliver accurate, on-time decisions, members get the care they need and the organization earns the trust that keeps our programs strong.

Schedule: Monday–Friday, 8:00 AM–5:00 PM Pacific Time, with rotating Saturday coverage as required.

What You’ll Actually Do

Decide with clinical rigor: Perform medical-necessity reviews and level-of-care determinations using benefit language, plan documents, medical policies, and nationally recognized evidence-based criteria such as MCG (and NCCN as applicable), in line with state and federal requirements.
Apply criteria consistently: Hold to policy every time, and when a request doesn’t meet criteria, route it promptly to the Medical Director for secondary clinical review and potential adverse determination per UM policy and accreditation standards.
Dig into the documentation: Analyze clinical records for completeness, spot risk and acuity indicators, flag inconsistencies or missing information, and start outreach or escalation right away per UM workflow.
Prioritize what can’t wait: Organize your workload around urgency, regulatory and accreditation time frames, and potential member impact, and raise barriers early so determinations stay timely and compliant.
Steer care in-network: Confirm eligibility, benefits, authorization requirements, and network status to support benefit-compliant redirection when it’s clinically appropriate.
Power the appeals process: Prepare clinical summaries and supporting documentation, coordinate peer-to-peer and Medical Director discussions when indicated, and route cases on time per policy, including Independent Review Organization (IRO) processes when required.
Document with precision: Record reviews, rationale, criteria and policy citations, communications, and outcomes accurately and in real time in designated UM systems to support quality oversight, reporting, and audit readiness.
Hit the standard: Meet productivity, quality, accuracy, and turnaround-time expectations, take part in calibration and quality activities, and put feedback to work in your daily practice.
Protect member privacy: Maintain HIPAA compliance and confidentiality using minimum-necessary standards, and complete required training and annual competencies by their deadlines.
Back up the team: Cross-train and provide cross-coverage to keep operations running and service-level commitments met.

Qualifications

What You Bring to Our Team

Education & Experience:

Current, unrestricted RN license in the United States or a U.S. territory (compact license acceptable where applicable)
Graduate of an accredited nursing program (ADN or diploma required; BSN preferred)
Minimum 1–2 years of recent clinical experience in acute care, med-surg, ICU/ED, or another relevant setting
Prior utilization review or utilization management experience preferred

Technical Skills:

Ability to interpret medical records and apply evidence-based criteria and plan medical policies, with appropriate escalation to the Medical Director for non-certifications
Working knowledge of MCG, NCCN (as applicable), NCQA and URAC standards, and HIPAA requirements
Knowledge of medical claims and ICD-10, CPT, and HCPCS coding
Proficiency in Microsoft Word, Excel, and Outlook
Basic computer literacy, proficient typing, and the ability to work across multiple screens
Ability to work independently within UM systems and programs after training

Benefits

The Highlights:

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions (yes, we use what we build)
Paid Time Off - rest and recharge time is non-negotiable
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks.

Compensation: This position offers a base salary range of $35.00-$38.00 per hour, depending on location, skills, and experience. You're eligible for our full benefits package starting day one.

Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive - because diversity is core to who we are and critical to our work in health and wellbeing.

Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to talent@personifyhealth.com. View all legitimate openings at personifyhealth.com/careers.

Apply on careers-personifyhealth.icims.com About employer

More about this job

Skills

Documentation
Workflow
Reporting
Acute care
CPT
HCPCS
Microsoft Word
Microsoft Excel
Microsoft Outlook
Computer skills
Work independently

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Work requirements

Jobs in the United States