- Appcast (Randallstown, MD)
- Utilization Review Nurse RN Randallstown, MD NORTHWEST HOSPITAL NW CARE MANAGEMENT Full-time - Day shift - 8:00am-4:30pm RN Other 92327 $38.20-$59.21 ... system that values bold ideas and community-centered care. The Utilization Review Nurse RN conducts initial, concurrent...by payor. Monitors and identifies patterns or trends in utilization management . Monitors potential and actual denials… more
- CoxHealth (Branson, MO)
- …to other team members. Excellent communication skills, leadership ability, time management , and problem solving skills required. * Job Requirements ◦ Education ... the institution. ▪ Working knowledge in human relations, customer service, inventory management . ▪ Ability to work with multiple people while meeting numerous… more
- Legend Biotech USA, Inc. (Raritan, NJ)
- …including but not limited to Operations, MSAT, Facilities, C&Q, Project Management , and Quality.Work closely with Sr. Manager, Strategic Initiatives to support ... of site operational models to better understand and assess resource utilization , equipment utilization , change impact, etc.Support assessment of facility… more
- CoxHealth (Lake Spring, MO)
- …physician documentation in the medical record through concurrent chart review . Interdisciplinary communication and collaboration with physicians, nursing, and ... ancillary staff including Health Information Management coders is key to the success of this...regarding proper clinical documentation utilizing approved guidelines. Understand and utilization of ICD-10-CM and PCS coding assignment and follow… more
- JobElephant (Bowling Green, OH)
- …and leading the operational and logistical functions for BGSU Firelands Events Management activities. This position acts as project manager for external clients to ... Space; Set-up; Dates/Times). All records must be entered into the event management system for all event information and contracts, R25 for space reservations,… more
- The Career Sphere (Los Angeles, CA)
- …clinical site? Supervise medical providers including providing timely performance feedback, review of peer review findings, performance evaluations, continuous ... customer service, and clinic flow.? With the help of clinic management and administrative assistance, manage provider panels, provider schedules, vacations, absences… more
- Centene Corporation (Austin, TX)
- … team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Tufts Medicine (Burlington, MA)
- …to the utilization of resources, coordination of care across the continuum and utilization review and management . The position develops and leads the ... leaders, to review metrics and discuss any operational issues. Coordinates Utilization Management meetings and deliverables. 6. Acts as Co-chair System UM… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials … 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...as needed to assist with patient care coordination and utilization review . The incumbent will be responsible… more
- Centene Corporation (Phoenix, AZ)
- … utilization management . + Oversees the behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines + Reviews ... Tempe and/or Tucson offices.** **Position Purpose:** Manages the behavioral health (BH) utilization review clinicians to ensure appropriate care to members.… more
- Alameda Health System (Oakland, CA)
- Director, 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
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... reports to the Director of Utilization Management * Oversees clinical decision review for services requiring prior authorization in a variety 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, Barksdale ... organization, professional organizations, and community health care facilities concerning Utilization Management . + Participates in in-services and continuing… 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 ... Utilization Management Manager Date Posted: Sep... Utilization Management Manager Date Posted: Sep 26, 2025 Requisition...high quality care and services. You serve as the utilization management subject-matter expert in health care… more
- Crouse Hospital (Syracuse, NY)
- …education and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse (RN) to track and manage data and ... of services. Pay Range: $80,000.00 / year + Utilization Management RNs are eligible for up...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… more
- UPMC (Pittsburgh, PA)
- …and full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including ... MD or DO for a fully remote Medical Director, Utilization Management role. The Medical Director, ...and potential quality of care concerns. + Provide expedited review and determination of medically pressing issues in accordance… more
- McLaren Health Care (Flint, MI)
- We are looking for a Utilization Management RN, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- Commonwealth Care Alliance (Boston, MA)
- …and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- UPMC (Pittsburgh, PA)
- …Life Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, ... The Medical Director, Utilization Management is responsible for assuring...and potential quality of care concerns. + Provide expedited review and determination of medically pressing issues in accordance… more
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