- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical ...this position is able to cover a multitude of utilization review functions through point of entry,… more
- New York State Civil Service (Bronx, NY)
- NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), New York City Children's Center - Bronx Campus, P27076 Occupational ... New York City Children's Center - Bronx Campus is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and efficiency… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- Utilization Review Nurse (37.5 Hour) Office/On-Site Recruitment # 251114-5612XC-001 Location Middletown, CT Date Opened 11/18/2025 12:00:00 AM Salary $73,574* - ... (https://portal.ct.gov/DMHAS/About-DMHAS/Agency/About-DMHAS) ) is now hiring for the position of Utilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612XC&R1=&R3=) to join their… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise ... position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and...regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and...procedure, identifies and refers potential quality of care and utilization issues to Medical Director. + Utilizes… more
- LifeCenter Northwest (Bellevue, WA)
- Organ Utilization Coordinator Job Details Job Location Bellevue HQ - Bellevue, WA Position Type Full Time Salary Range $75918.00 - $110112.00 Salary Job Posting ... Date(s) Start Date 08/05/2025 Description and Qualifications The Organ Utilization Coordinator (OUC) is accountable for overseeing all activities related to the… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- State of Indiana (Indianapolis, IN)
- …The role of Utilization Management Manager oversees the integration of utilization review , clinically appropriate care and risk management for the purpose ... Utilization Management Manager Date Posted: Nov 1, 2025...paid to thousands of service providers ranging from major medical centers to a physical therapist working with a… more
- Commonwealth Care Alliance (Boston, MA)
- …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Humana (Lincoln, NE)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization … more
- Intermountain Health (Las Vegas, NV)
- …Care Management I leads and collaborates with care management operations across utilization review , acute and emergency department care, and ambulatory/community ... Qualifications** + Previous management experience in hospital care management, utilization review , ambulatory care management, ambulatory utilization… more
- Humana (Concord, NH)
- …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- CenterWell (Austin, TX)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- Molina Healthcare (NM)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN with a compact license who resides in New Mexico or Texas. This team ... required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or...as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only). Must be able to travel… more
- Ventura County (Ventura, CA)
- …+ Experience with managed care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs + At ... care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review ...Review systems and programs + Direct patient care medical practice experience + Administrative experience + National Committee… more
- Molina Healthcare (Spokane, WA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Molina Healthcare (NM)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Molina Healthcare (NV)
- **Job Description** **Job Summary** Provides support for member clinical review processes specific to applied behavioral analysis (ABA) services. Responsible for ... stay for requested treatments and/or procedures. * Works collaboratively with the utilization and care management departments to provide ABA and behavioral health… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …II (in addition to Level I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of ... recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- … management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review , ... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice...periods of time for business continuity. + Ability to travel across the Health Plan service region for meetings… more
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