- 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 (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
- Veterans Affairs, Veterans Health Administration (Winter Park, FL)
- …RN possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... to assess, organize, facilitate, and guide Veterans through their full range of care options including internal/direct care in... management experience 2 or more years of utilization review experience Reference: For more information… more
