- Eisai, Inc (Nutley, NJ)
- …new hire MSLs scientific training via didactic and coaching sessions, utilizing full curriculum modules, FAQs, reading guides, etc (note: region and need dependent; ... and MSL managers. Develop congress abstract tracker, assign MSL coverage, review MSL reporting responsibilities, collate and distribute Congress Report, execute pre-… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review ...+ Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time ... + Posted:July 14, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the appropriate… more
- Alameda Health System (Oakland, CA)
- … Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… more
- Alameda Health System (Oakland, CA)
- …Utilization Management SUM Specialist + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Care Management + ... FTE:1 + Posted:July 18, 2025 **Summary** **SUMMARY:** The System Utilization Management (SUM) Care Without Delay RN...and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full -time position supporting the 2d Medical Group, ... ASN from an accredited college or university Experience:** One year of experience in Utilization Management is required. Full time employment as a registered… more
- Trinity Health (Silver Spring, MD)
- … time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time **Shift:** Day ... Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management , you will be the key...care and address clinical documentation needs for accurate case review and status determination. + Oversee the continuity of… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** ... **Job Type:** Regular **Time Type:** Full time **Work Shift:** Day (United States of...and Serve Your Community!** **In your role as a Utilization Review & Denials Management … more
- Guthrie (Troy, PA)
- Up to a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic offices, ... Packer Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior… more
- Commonwealth Care Alliance (Boston, MA)
- …local regulatory guidelines. + Serve as the lead for CCA's Utilization Review functions working closely with other medical management team members. + Support ... review findings, actions, and outcomes in accordance with Utilization + Management policies; meets health plan...management experience required. + 2 or more years full -time experience practicing medicine + 3 or more years… more
- Elevance Health (Cerritos, CA)
- …experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management ** ; or ... **RN Nurse Reviewer I - California** Location: **Virtual** - This...**.** **Preferred Skills, Capabilities and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-10 and managed health… more
- Elevance Health (Nashville, TN)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... **Nurse Reviewer I** **Location:** **Virtual:** This role enables associates...RN license in applicable state(s) required. + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- Elevance Health (Nashville, TN)
- …license, especially in Florida, Georgia, Indiana, and/or Kentucky. + Experience in utilization management and/or reimbursement coding for genetic testing. + ... **Genetic Counselor Reviewer ** The Genetic Counselor Reviewer (GCR)...**Location:** Virtual: This role enables associates to work virtually full -time, with the exception of required in-person training sessions… more
- Centers Plan for Healthy Living (Margate, FL)
- …accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary ... care or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests… more
- CVS Health (Columbus, OH)
- …. + Independent clinical license preferred: LPCC, IMFT, or LISW + Managed care/ utilization review experience + Case management and discharge planning ... all with heart, each and every day. **Position Summary** The Care Plan Reviewer (Clinical Case Manager BH) utilizes advanced clinical judgment and critical thinking… more
- BJC HealthCare (St. Louis, MO)
- **City/State:** Saint Louis, Missouri **Categories:** Information Services **Job Status:** Full -Time **Req ID** : 94490 **Pay Range:** $47,361.60 - $77,126.40 / year ... work experience) **Additional Information About the Role** BJC is hiring for a Surgical/Clinical Reviewer . This is a remote position. Must be located in MO or IL. We… more
- Centene Corporation (Indianapolis, IN)
- …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Centene Corporation (Atlanta, GA)
- …appeals, and occasional peer-to-peer consultations, as well as participating in Utilization Management clinical rounds.** **We're seeking candidates who:** + ... Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or… more
- Corewell Health (Grand Rapids, MI)
- …SITE - Priority Health - 1231 E Beltline - Grand Rapids Department Name PH - Utilization Management Employment Type Full time Shift Day (United States of ... with external partners and reports directly to the Senior Director of Utilization Management . Essential Functions Strategic Leadership & Program Oversight: +… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review Full Time Days - 2506001796 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves ... for case management scope of services including: Utilization Management services supporting medical necessity and...level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,...state, local, and federal programs + Progressive knowledge of utilization management , case management , performance… more
