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R
ATE Test Engineer Intern
Rambus
San Jose, CA
- $25.8 to $47.8 USD / hour
As a Summer Intern - ATE Test Engineer, you will assist with automated test equipment (ATE) program development, product validation, test debugging, and yield improvement activities. You…
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Residential Administrator - 5878
ColumbiaCare Services
Milwaukie, OR
Must have prior work experience as a Residential Administrator or have a proven history as an Assistant Administrator within ColumbiaCare Services
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Peoria, AZ
- $41 to $51 USD / hour
13-week Pathway to Success leadership development program
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TG
Director/Onsite Owner
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Corinth, TX
- $70,000 to $90,000 USD / year
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Triage Specialist
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Houston, TX
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Added 1 min ago
Assistant Store Director (Multiple Locations)
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Centennial, CO · Denver, CO
Completion of ASD Training Program or a similar leadership development program.
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Director Imaging Operations and Nuclear Medicine Services
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United States
…or through supervisory staff, the nuclear medicine clinical operations for Brown University Health’s Medical Imaging division. In cooperation with the Medical Director of the division, the…
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Customer Service Supervisor
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Rancho Dominguez, CA
The Customer Service Supervisor supports the daily operations of the customer service team to ensure timely, accurate, and high‑quality service for all clients. This role provides direct…
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FE
Financial Planning & Analysis Advisor/Sr Analyst/Analyst
Federal Express Corporation
Plano, TX · Memphis, TN · Moon Township, PA
- $7,488.36 to $12,355.79 USD / month
Candidates must live within 50 miles of the campus location
Added 1 min ago
FE
Ops Supervisor - Hub
Federal Express Corporation
CHICAGO, IL
- $28.46 to $44.19 USD / hour
…FedEx Safety Above All Culture and manages specific day-to-day operations and an assigned staff. Responsible for ensuring safe and efficient package sortation through the management of…
Added 1 min ago
Senior All Source Analyst
Cherokee Federal
Dayton, OH
Develop, coordinate, and disseminate intelligence information used for programming platform mission data systems in development, testing, training, operations, and sustainment.
Added 1 min ago
PB
Senior Personal Banker (Float) - Metro/NY Region / Astoria (Full-time)
Provident Bank
Astoria, NY
- Full-time
…the management objectives being retention and relationship development. Serves as a liaison to actively refer and coordinate specialist support from lending, investment, trust specialists,…
Added 1 min ago
IT Sr. Solution Engineer – Development/ Integration
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Kansas City, KS
…were $12.2 billion. In addition to its cooperative wholesale operations, the company also operates subsidiary companies that provide certain real estate and supermarket development…
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Assistant Director of Alumni Relations
The Pingry School
Basking Ridge, NJ
Experience: 1–3 years of professional experience in alumni relations, event management, development operations, marketing, or high-level administrative support.
Added 2 mins ago
GT
Call Center Quality Assurance Supervisor - Remote CA
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Any city, CA
- $61,000 to $87,100 USD / year
Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards.…
Added 2 mins ago
Electrical Engineer 2
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Centennial, CO
…procurement, logistics, testing, other engineering functions, and operations as needed. Tasks include hardware selection, reviewing and editing complex engineering drawings, parts lists,…
Added 2 mins ago
GT
Dental Consultant: Oral Surgeon- California (Part-time)
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- $138,200 to $197,400 USD / year
- Part-time
Candidates must possess intermediate-level computer proficiency and be comfortable using standard business applications and systems · Candidates must reside and work in California
Added 2 mins ago
Sr. Manager, SDR Enablement Business Partners
Motive
Austin, TX
Motive empowers the people who run physical operations with tools to make their work safer, more productive, and more profitable. For the first time ever, safety, operations and finance…
Added 3 mins ago
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Intern, Maritime Business Data Analytics (HAL)
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Seattle, WA
- $25 to $30 USD / hour
The intern will support the development and enhancement of technical, safety, and financial reporting tools used by maritime operations leaders and shipboard teams to monitor performance,…
Added 3 mins ago
Clinical Pharmacist - Brooklyn, New York
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Brooklyn, NY
An opportunity is available for a Clinical Pharmacist with expertise in retail and specialty outpatient pharmacy operations, regulatory compliance, and 340B program management. This…
Added 3 mins ago
Clinical Pharmacist - New York, New York
Soliant Health
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…lasting 6 to 12 months, focusing on outpatient retail pharmacy operations and 340B program management. This role extends beyond traditional dispensing duties and requires expertise in…
Added 3 mins ago
CO
Deputy Police Chief
City of Asheville
Asheville, NC
- $122,581.28 to $183,871.91 USD / year
Must possess and maintain, or be eligible to possess and maintain, a valid North Carolina driver’s license · Specific License or Certification Required: Must possess and maintain a valid North Carolina driver’s license
Added 3 mins ago
Information Systems Security Officer
Chenega Corporation
Huntsville, AL
Must have active CompTIA Security+ certification in accordance with DoD 8570/8140 requirements · Must have active Secret clearance with ability to obtain TS with SCI eligibility

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