• Aequor (San Diego, CA)
    …goods, and as required, internal shipment requests. Support identification and management of 's domestic and international contract storage warehouse's for ... systems and procedures preferably with a virtual pharmaceutical company Experience in utilization of ERP based systems a plus Strong interpersonal skills with… more
    HireLifeScience (10/02/25)
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  • Utilization Management

    Mount Sinai Health System (New York, NY)
    **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
    Mount Sinai Health System (10/03/25)
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  • Utilization Review Specialist

    MetroHealth (Cleveland, OH)
    ** Utilization Review Specialist - Utilization Management ** **Location:** **METROHEALTH MEDICAL CENTER** **Biweekly Hours:** **80.00** **Shift:** ... communicating information to internal and external customers of the Utilization Review and Care Management Department. Follows...customers of the Utilization Review and Care Management Department. Follows up on inquiries from payors and… more
    MetroHealth (08/20/25)
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  • ABA Utilization Review (UR)…

    Spectrum Billing Solutions (Skokie, IL)
    …mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist | Revenue ... Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health Billing … more
    Spectrum Billing Solutions (09/01/25)
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  • Utilization Management

    Vanderbilt University Medical Center (Tullahoma, TN)
    …preeminent programs in patient care, education, and research. **Organization:** Utilization Management 10 **Job Summary:** Facilitates optimal reimbursement ... admission status is ordered. The nurse conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review when… more
    Vanderbilt University Medical Center (09/22/25)
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  • Utilization Management

    AnMed Health (Anderson, SC)
    Responsible for performing daily operations of Utilization Management (UM) program including certification management , medical necessity determinations, ... performance tracking and regulatory compliance. Qualifications: Requires current SC RN. Minimum of two years of clinical experience required. UM experience preferred but not required. more
    AnMed Health (09/11/25)
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  • Manager, Utilization Management

    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 ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
    Commonwealth Care Alliance (10/02/25)
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  • Authorization Technician II

    LA Care Health Plan (Los Angeles, CA)
    …to achieve that purpose. Job Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and ... Authorization Technician II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition… more
    LA Care Health Plan (08/29/25)
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  • Sr Utilization Review Specialist

    Houston Methodist (Houston, TX)
    …the leadership team for special project activities related but not limited to, throughput, utilization review and utilization management to align with the ... At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position...members. + Serves as the primary information resource for utilization management staff, payers, physicians, and other… more
    Houston Methodist (08/26/25)
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  • Regional Utilization Review Documentation…

    Trinity Health (Maywood, IL)
    …in collaboration with attending physicians. + Actively participates in the Utilization Management committee. + Additional responsibilities as needed. **We ... Loyola campus. Position is hybrid, must reside in Illinois. The **Regional Utilization Review Documentation Specialist ** nurse works with the multidisciplinary… more
    Trinity Health (10/01/25)
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  • Utilization Review Specialist

    BriteLife Recovery (Englewood, NJ)
    …compliance. + Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials, approvals, ... What you will be doing? The Utilization Review (UR) Specialist is a...you? + Minimum of 2-3 years of experience in utilization review, case management , or insurance coordination… more
    BriteLife Recovery (10/04/25)
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  • RN Utilization Review Specialist Per…

    HonorHealth (AZ)
    …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of ... of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Responsible for coordinating and conducting medical… more
    HonorHealth (09/10/25)
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  • Insurance Specialist -Mount Sinai West-…

    Mount Sinai Health System (New York, NY)
    …Excel and Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt...EOW** To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring… more
    Mount Sinai Health System (07/23/25)
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  • Sr Spec-Integrated Care Mgmt - Utilization

    Sharp HealthCare (San Diego, CA)
    …will track and maintain this certification.For Sr Spec ICM assigned to Utilization Management , Train-the-Trainer certification may substitute for ACM or CCM. ... will track and maintain this certification.For Sr Spec ICM assigned to Utilization Management , Train-the-Trainer certification may substitute for ACM or CCM.… more
    Sharp HealthCare (08/02/25)
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  • Utilization Management (UM) Program…

    Community Based Care of Brevard, Inc. (Orlando, FL)
    …a web-based application for daily entry of case activity and the utilization management of service authorizations. Educational and Experience Requirements: MA/MS ... $65,000/year Position Summary: The UM Program Manager provides oversight and management of service authorization data validation, reporting and trend analysis… more
    Community Based Care of Brevard, Inc. (10/04/25)
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  • Utilization Review Manager

    Minnesota Visiting Nurse Agency (Minneapolis, MN)
    … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... financial, and utilization goals through effective management , communication, and...appropriate * Collaborates with department director and professional development specialist to develop standard work and expectations for the… more
    Minnesota Visiting Nurse Agency (09/30/25)
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  • RN Utilization Review Remote

    HonorHealth (AZ)
    …communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Responsible for coordinating and conducting medical… more
    HonorHealth (09/26/25)
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  • Senior Denials Mgmt Specialist

    Houston Methodist (Sugar Land, TX)
    At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the ... with clinical team partners. This position uses sound clinical judgement in the Utilization Management process and knowledge of regulatory requirements to make… more
    Houston Methodist (07/31/25)
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  • Enhanced Care Management Clinical…

    LA Care Health Plan (Los Angeles, CA)
    …the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and ... Enhanced Care Management Clinical Specialist II Job Category:... Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer:… more
    LA Care Health Plan (07/16/25)
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  • PRN UR Clinical Specialist

    Community Health Systems (Franklin, TN)
    …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... **Job Summary** The Clinical Utilization Review Specialist is responsible for...extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key… more
    Community Health Systems (09/18/25)
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