- Campbell County Health (Gillette, WY)
- …focuses on integrating care management , social services, discharge planning, utilization review and post-hospital services to ensure clinical efficacy and ... Promotes empowerment of resident in self- management of disease process. * Utilization review of the resident stay is done in a timely manner and is… more
- Luminis Health (Lanham, MD)
- …to the unit at education/staff development functions as well as designated management functions to promote high quality, cost effective health care. This position ... to hiring, evaluating performance, issuing final disciplinary actions under the review of Human Resources, and recommending discharge in collaboration with members… more
- Luminis Health (Lanham, MD)
- …to the unit at education/staff development functions as well as designated management functions to promote high quality, cost effective health care. This position ... to hiring, evaluating performance, issuing final disciplinary actions under the review of Human Resources, and recommending discharge in collaboration with members… more
- Saint Vincent Hospital (Worcester, MA)
- …clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions. Together as an enterprise, we work to ... to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and right to… more
- Unknown (Greensboro, NC)
- …includes overseeing contract negotiations, patient accounting, collections, insurance processes, and the utilization review cycle. The CFO will also manage the ... a CPA and at least two years of senior management experience. The ideal candidate for the CFO position...a CPA. A minimum of two years of senior management experience is required. The CFO will be responsible… more
- Centene Corporation (Austin, TX)
- … utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines + Monitors ... skill sets and work experience:** + Direct experience with Utilization Review or Utilization Management related to Behavioral Health case is preferred +… more
- Centene Corporation (New York, NY)
- …care, provider interactions, and facilitates operations within utilization management . + Manages prior authorization, concurrent review , and retrospective ... with applicable guidelines, policies, and procedures + Reviews and analyzes utilization management activities, operations, costs, and forecasted data to… more
- Centene Corporation (Madison, WI)
- … 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
- 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
- Fallon Health (Worcester, MA)
- …strategic leadership and oversight responsibility for the clinical and operational utilization management activities for all inpatient and outpatient care, ... and staff across all product lines. **Responsibilities** ** Utilization Management :** + Oversees all administrative, operational and clinical functions related to… more
- UNC Health Care (Morrisville, NC)
- …the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible ... for designing, implementing, and standardizing utilization management functions across a large healthcare...Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate… more
- CVS Health (Austin, TX)
- …+ Job Description Primary Job Duties & Responsibilities Drives effective utilization management practices by ensuring appropriate and cost-effective allocation ... efficient use of healthcare resources. Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the ... care standards for appropriate utilization of services. Perform utilization management / review for medical necessity for specialty referrals and… 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
- CentraCare (St. Cloud, MN)
- …You will be responsible to conduct key components of the St Cloud Hospital Care Management and Utilization Review (UR) plans which includes activities to ... St. Cloud Hospital is seeking a dynamic and experienced Utilization Management RN to join our team....in any of the following functions: utilization review , performance improvement, quality assurance, risk management … 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: Jan... Utilization Management Manager Date Posted: Jan 6, 2026 Requisition...high quality care and services. You serve as the utilization management subject-matter expert in health care… more
- CVS Health (Austin, TX)
- …And we do it all with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can ... department.** **Rotational late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to… more
- AmeriHealth Caritas (Washington, DC)
- …meet the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of ... **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity...cases are escalated to the Medical Director for further review . The reviewer independently applies medical and… more
- CVS Health (Baton Rouge, LA)
- …Lead, coach, and develop a multidisciplinary team responsible for utilization review , prior authorization, and case management functions. + Monitor team ... we do it all with heart, each and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical… more
- Humana (Little Rock, AR)
- …analysis and integrated care needs for those with autism + Prior experience with Utilization Review , Utilization Management , Peer Reviews and/or Quality ... caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes...appropriate treatment, care, or services for ACD participants. + Review ABA TPs for policy compliance + Review… more
