- Merck & Co. (Rahway, NJ)
- …Solutions, Management Process, Management System Development, Problem Management , Quality Assurance (QA), Resource Planning, Service Delivery, SLA ... requirements to ensure uninterrupted effective delivery.Developing and maintaining resource utilization and capacity planning, including utilizing a standardized cost… more
- Novo Nordisk Inc. (Walnut Creek, CA)
- …productively and respectably challenge and influence target physicians' approach to patient management and adds value by sharing new information and unique insights ... external customers and during company sponsored meetings: Strategic Planning- Pre -Call Planning, Post-Call Analysis Creates Customer Engagement-Open Purposefully, Uncover… more
- Ventura County (Ventura, CA)
- Per Diem Registered Nurse II/III - Utilization Management VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply Per Diem ... Registered Nurse II/III - Utilization Management VCMC Salary $109,727.64 - $184,627.89...If presently permanently employed in another "merit" or "civil service " public agency/entity in the same or substantively similar… more
- Adecco US, Inc. (Minneapolis, MN)
- Adecco Healthcare & Life Sciences is hiring ** Utilization Management Nurses** ! This role is work from home and remote but we are requiring Nurses to live in ... $43.25 per hour based on experience **Responsibilities of the Utilization Management Nurse** : . Responsible for...direct supervision of an RN or MD. . Performs utilization review activities, including pre -certification, concurrent, and… more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary ... team to perform reviews of service authorization requests, ensuring the utilization of...activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management … more
- Houston Methodist (The Woodlands, TX)
- …eligibility for state, local, and federal programs + Progressive knowledge of utilization management , case management , performance improvement, and managed ... At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a...any denials to the appropriate case manager, denials, and pre -bill team members, as well as management .… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Assistant **Cottingham & Butler/ SISCO** 1 Positions ID: 4823157008 Posted On 07/28/2025 **Job Overview** ** Utilization Management ... and thrive in a fast-paced, professional environment? We are seeking a dedicated ** Utilization Management Assistant** to join our healthcare team. This role is… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...UM Manager and Physician Advisor on case reviews for pre - service , concurrent, post- service and retrospective… more
- Veterans Affairs, Veterans Health Administration (Winter Park, FL)
- …knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ... discharge or until transfer to the VA. The CC Utilization Management RN will work collaboratively within...Responsible for the documented outcomes at the program or service level. Program or service level outcomes… more
- Houston Methodist (Sugar Land, TX)
- …Provides education to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of department scores for ... any denials to the appropriate case manager, denials, and pre -bill team members, as well as management ....state, local, and federal programs + Comprehensive knowledge of utilization management , case management , performance… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- … pre -certification, concurrent, and retrospective reviews with emphasis on utilization management , discharge planning, care coordination, clinical outcomes, ... your true colors to blue. The Role The RN Utilization Management Reviewer is responsible for facilitating...and quality of service + Self-directed, independent, adaptive, flexible to change, and… more
- Commonwealth Care Alliance (Boston, MA)
- …Director will be responsible for providing leadership and subject matter expertise to our utilization management (UM) group. This role is a key role in helping ... management team members. + Support the development of utilization management policy initiatives. + Support the...VP of UM to direct the efforts of the utilization review and pre -certification functions to accomplish… more
- Dignity Health (Bakersfield, CA)
- …review based on medical necessity. The position partners with both the Pre - Service and In-Patient Utilization Management teams. Ensures to monitor and ... as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the… more
- Actalent (Redlands, CA)
- Job Title: Case Manager - Utilization ManagementJob Description Join our dynamic Utilization Management team as a Case Manager, where you will play a pivotal ... role in Care Coordination. You will review healthcare service requests to ensure they meet medical necessity and...Medicare, MediCal, and Milliman Criteria Guidelines. + Experience in utilization management and working with provider offices.… more
- Elevance Health (FL)
- ** Utilization Management Representative III** **Location:** This role enables associates to work virtually full-time in Florida, with the exception of required ... of operation are 6 am - 6 pm EST including weekends. The ** Utilization Management Representative III** is responsible for coordinating cases for precertification… more
- AdventHealth (Glendale Heights, IL)
- …AVE, Glendale Heights, IL 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... strategies including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a designated patient… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …responsibility for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Follows ... the interdisciplinary team. Responsibilities Duties include but not limited to: Utilization Review (UR) Registered Nurse (RN) is responsible for providing competent,… more
- Humana (Miramar, FL)
- …physician, referral source and provider interactions and communications. Work with Pre -Authorization, Utilization Management , Billing, Pharmacy, Home Care ... our caring community and help us put health first** Job Description Summary The Pre - Service Coordinator is responsible for all aspects of referral management … more
- Catalent Pharma Solutions (Philadelphia, PA)
- **Manager Pre -Production and Label Control** **Position Summary** Catalent, Inc. is a leading global contract development and manufacturing organization (CDMO) whose ... better and healthier lives. Catalent is dedicated to delivering unparalleled service to pharma, biotech, and consumer health customers, supporting product… more
- RWJBarnabas Health (New Brunswick, NJ)
- Asst Director Patient Care , Pre /Post SurgicalReq #:0000202858 Category:Leadership Status:Full-Time Shift:Day Facility:RWJ New Brunswick Department: Pre /Post ... Job Title: Asst Director Patient Care Location: RWJ New Brunswick Department: Pre /Post Surgical Req#: 0000202858 Status: Full-Time Shift: Day Pay Range: $108,100.00… more
