- Insight Global (Mayfield Heights, OH)
- …Agile/Scrum experience Advanced domain knowledge of case, disease and utilization management /coordination/assessments, HEDIS quality and HIE Ability to ... dynamics toward the successful completion of requirements development and management including facilitation of requirements gathering, review, acceptance, prioritization,… more
- CVS Health (Phoenix, AZ)
- …promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Key Responsibilities** + ... with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we...a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM… more
- Centene Corporation (Jefferson City, MO)
- …experience required 10+ years of nursing, utilization management , or case management experience in an acute care setting required Experience in managed ... complex and often conflicting requirements. + Oversee the operations of utilization management , reconciliation coordination, concurrent review (telephonic and… more
- CVS Health (Denver, CO)
- … and Utilization Management . AHH delivers flexible medical management services that support cost-effective quality care for members. Utilizes clinical ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Utilizes clinical experience and skills in a… more
- CVS Health (Harrisburg, PA)
- …Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization . The Utilization Management Clinician will work in ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
- Penn Medicine (Lancaster, PA)
- …day. Are you living your life's work? Summary: + Position Summary: The Utilization Management Specialist - Denials is responsible for evaluating medical records ... insurance benefit structures and related legal medical issues. + Knowledge of utilization management and quality improvement processes. + Experience working… more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Utilization Review Specialist ( Remote Option in Wisconsin) **Cost Center:** 101651289 ... **_Remote work available for Wisconsin residents only_** **JOB SUMMARY** The Utilization Review Specialist, Revenue Cycle Provide quality assurance of medical … more
- Trinity Health (Columbus, OH)
- …to the UM Program and at the direction of the Sr. Director of Medical Management . + Coordinates with the utilization review, case management , discharge ... 5-7 years of clinical nursing experience with at least 2 years' experience in utilization review or case management . Nursing experience in an HMO insurance… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …coding standards + Maintains current and working knowledge of Utilization Management Standards. + Experience in interpreting managed care benefit plans and ... customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough...of care . + Collaborates with hospital, home care , care management , and other… more
- Centene Corporation (Tallahassee, FL)
- …to performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH care member issues related to BH ... ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization … more
- Centene Corporation (Jefferson City, MO)
- …team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues + Maintains… more
- AmeriHealth Caritas (Philadelphia, PA)
- …in a clinical setting + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization + Experience utilizing ... state contract, policies, and regulations pertaining to Pediatric Shift Care services **Work Arrangement;** + Remote +...those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty… more
- UPMC (Pittsburgh, PA)
- The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Assistant **Cottingham & Butler/ SISCO** 1 Positions ID: 4755768008 Posted On 07/01/2025 **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
- AmeriHealth Caritas (Newark, DE)
- …www.amerihealthcaritas.com. **Responsibilities:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical ... times, quality benchmarks, and efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted… more
- Trinity Health (Silver Spring, MD)
- …time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time **Shift:** Day **Location** : ... Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management , you will be the key... and reduce unnecessary costs while maintaining high-quality patient care . + ** Remote Opportunity -** Must live… more
- CVS Health (Charleston, WV)
- …more compassionate. And we do it all with heart, each and every day. ** Utilization Management Clinical Consultant** ** Remote - West Virginia** Schedule is ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is… more
- CVS Health (Columbus, OH)
- …day. **Position Summary** This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a field-based/ Remote position out of the ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- CVS Health (Richmond, VA)
- …Monday through Friday 8:30-5pm EST. No weekends or holidays. + 1+ years of utilization review/ utilization management required. + 3+ years of behavioral ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- Humana (Charleston, WV)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more