{"schemaVersion":"jobsearcher.job.v1","id":"2cf0b242bd983b12895ff686","url":"https://jobsearcher.com/jobs/2cf0b242bd983b12895ff686","canonicalUrl":"https://jobsearcher.com/jobs/2cf0b242bd983b12895ff686","title":"Utilization Management Nurse","description":"Essential Responsibilities/Accountabilities:\nThis job is hybrid and requires some weekly in office work\nPromote the use of evidence-based care through extensive use of NCCN Guidelines®, Clinical Trials.gov, McKesson Clear Value Plus, and the use of our COE networks\nAssess new patients’ need for treatment at a Center of Excellence Facility\nDocument all activities in electronic medical record (EMR)\nPerform all duties efficiently while keeping cost containment and patient centric quality care a priority\nEffectively communicates the status of patient activities through the use of PA’s, Notification Forms, email and/or telephone.\nUnderstands and makes decisions based upon benefit plan language.\nAssists with organizing services across provider lines, between people and systems to affect optimal patient outcomes, achieve continuity of care and reduce costs\nServes as a utilization management resource to determine appropriateness of treatment plan, level of care\nMaintains a working knowledge of Medicare and private insurance companies and ensures that quality of care is maintained or surpassed by collecting quality indicators and variance data and reporting data to appropriate person(s) and/or department(s)\nPerforms other duties as assigned and accepts new tasks as opportunities for growth\nCollaborates with health care team members to develop a multidisciplinary plan of care and sets patient-centered goals for patient/families\nFacilitates and/or participates in discussions that provide ongoing evaluation of interdisciplinary intervention, goal attainment, and treatment plan revision\nKnowledgeable about the patient’s financial status, diagnosis and discharge needs to develop the plan of care\nAlso maintains an awareness of the patient’s psychosocial situation, including identification of potential barriers which may impact patient compliance and facilitates the coordination of referrals as appropriate\nProvides ongoing communication with patients, families, medical staff, care givers and third-party payers, to include utilization assessment for pre-authorization\nCommunicate with providers to ensure clinical documentation supports the service and level care provided to the patient\nWork cohesively with triage center Intake Coordinators and Oncology Nurse Experts\nAdditional Responsibilities:\nMaintain integrity of company image, philosophy, and methods in all communications\nRepresent CancerCARE and health plans by being professional at all times.\nJob Qualifications (Knowledge, Skills and Abilities):\nRN with active license (Compact state license preferred)\nExcellent relationship-building skills\nExcellent verbal and written communication skills\nExemplary computer and technical skills. Feel comfortable with learning new technology and troubleshooting technology\nProficiently type directly into an electronic medical record while obtaining information telephonically from the patient\nStrong organizational skills with the ability to multi-task\nProficient in Microsoft Office\nStrong analytical and problem-solving skills\nSelf-motivated\nAble to work independently and in a team environment\nEducation and Experience:\nRN with active license; Compact State license and Oncology experience preferred\nManagement experience desired\nMust have familiarity with reviewing medical records\nExperience in or knowledge of insurance, TPA, or medical stop-loss and reinsurance industry preferred\nMust have Oncology/NCCN experience\nJob Type: Full-time\nPay: $90,000.00 - $95,000.00 per year\nBenefits:\n401(k)\nEmployee assistance program\nFree parking\nLife insurance\nSchedule:\nDay shift\nMonday to Friday\nExperience:\nOncology: 3 years (Required)\nLicense/Certification:\nCompact State Nurse License (Required)\nWork Location: Hybrid remote in Rockwall, TX 75087","company":"Interlink Coe Networks Programs","rawCompany":"interlink coe networks programs","city":"Rockwall","state":"TX","isRemote":false,"isActive":false,"createdAt":"2026-08-04T14:55:33.956Z","occupations":[{"code":"29-1141.00","title":"Registered Nurses","slug":"registered-nurses"},{"code":"29-1141.04","title":"Clinical Nurse Specialists","slug":"clinical-nurse-specialists"},{"code":"29-1141.01","title":"Acute Care Nurses","slug":"acute-care-nurses"}],"industries":[{"code":"622110","title":"General Medical and Surgical Hospitals","slug":"general-medical-and-surgical-hospitals"},{"code":"622310","title":"Specialty (except Psychiatric and Substance Abuse) Hospitals","slug":"specialty-except-psychiatric-and-substance-abuse-hospitals"},{"code":"621111","title":"Offices of Physicians (except Mental Health Specialists)","slug":"offices-of-physicians-except-mental-health-specialists"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"Utilization Management Nurse","description":"Essential Responsibilities/Accountabilities:\nThis job is hybrid and requires some weekly in office work\nPromote the use of evidence-based care through extensive use of NCCN Guidelines®, Clinical Trials.gov, McKesson Clear Value Plus, and the use of our COE networks\nAssess new patients’ need for treatment at a Center of Excellence Facility\nDocument all activities in electronic medical record (EMR)\nPerform all duties efficiently while keeping cost containment and patient centric quality care a priority\nEffectively communicates the status of patient activities through the use of PA’s, Notification Forms, email and/or telephone.\nUnderstands and makes decisions based upon benefit plan language.\nAssists with organizing services across provider lines, between people and systems to affect optimal patient outcomes, achieve continuity of care and reduce costs\nServes as a utilization management resource to determine appropriateness of treatment plan, level of care\nMaintains a working knowledge of Medicare and private insurance companies and ensures that quality of care is maintained or surpassed by collecting quality indicators and variance data and reporting data to appropriate person(s) and/or department(s)\nPerforms other duties as assigned and accepts new tasks as opportunities for growth\nCollaborates with health care team members to develop a multidisciplinary plan of care and sets patient-centered goals for patient/families\nFacilitates and/or participates in discussions that provide ongoing evaluation of interdisciplinary intervention, goal attainment, and treatment plan revision\nKnowledgeable about the patient’s financial status, diagnosis and discharge needs to develop the plan of care\nAlso maintains an awareness of the patient’s psychosocial situation, including identification of potential barriers which may impact patient compliance and facilitates the coordination of referrals as appropriate\nProvides ongoing communication with patients, families, medical staff, care givers and third-party payers, to include utilization assessment for pre-authorization\nCommunicate with providers to ensure clinical documentation supports the service and level care provided to the patient\nWork cohesively with triage center Intake Coordinators and Oncology Nurse Experts\nAdditional Responsibilities:\nMaintain integrity of company image, philosophy, and methods in all communications\nRepresent CancerCARE and health plans by being professional at all times.\nJob Qualifications (Knowledge, Skills and Abilities):\nRN with active license (Compact state license preferred)\nExcellent relationship-building skills\nExcellent verbal and written communication skills\nExemplary computer and technical skills. Feel comfortable with learning new technology and troubleshooting technology\nProficiently type directly into an electronic medical record while obtaining information telephonically from the patient\nStrong organizational skills with the ability to multi-task\nProficient in Microsoft Office\nStrong analytical and problem-solving skills\nSelf-motivated\nAble to work independently and in a team environment\nEducation and Experience:\nRN with active license; Compact State license and Oncology experience preferred\nManagement experience desired\nMust have familiarity with reviewing medical records\nExperience in or knowledge of insurance, TPA, or medical stop-loss and reinsurance industry preferred\nMust have Oncology/NCCN experience\nJob Type: Full-time\nPay: $90,000.00 - $95,000.00 per year\nBenefits:\n401(k)\nEmployee assistance program\nFree parking\nLife insurance\nSchedule:\nDay shift\nMonday to Friday\nExperience:\nOncology: 3 years (Required)\nLicense/Certification:\nCompact State Nurse License (Required)\nWork Location: Hybrid remote in Rockwall, TX 75087","datePosted":"2026-08-04T14:55:33.956Z","dateModified":"2026-08-04T14:55:33.956Z","hiringOrganization":{"@type":"Organization","name":"Interlink Coe Networks Programs","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Rockwall","addressRegion":"TX","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"2cf0b242bd983b12895ff686"},"url":"https://jobsearcher.com/jobs/2cf0b242bd983b12895ff686"}}