• Kaiser (Arlington, VA)
    …inappropriate utilization of medical services.In close collaboration with the nurse case manager and other members of the health care team, develops and ... population, responsible for collaborating with the members of the health care team to facilitate the coordination of appropriate, cost-effective services that… more
    Talent (09/15/25)
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  • Boost Home Health (Southfield, MI)
    …possible? Are you passionate about promoting quality of life by providing world-class care ? Inspired by nurses, Boost Home Healthcare makes it easier for patients to ... focus on recovery and wellness by personalizing and coordinating care . As a member of our team, you'll play...healthiest and happiest state of being possible. The Clinical Manager is a Registered Nurse (RN) who has graduated… more
    Upward (08/04/25)
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  • PharmaCord (Jeffersonville, IN)
    …team immediately at ###@pharmacord.com As an Oncology Registered Nurse (RN) Case Manager you are responsible for contact with program patients and assessing any ... completion of therapy. The Oncology Registered Nurse (RN) Case Manager will play an active role with each patient...diagnosis. Empower the patient to participate in their personal care process by triaging the patient to support for… more
    Upward (08/01/25)
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  • GALEN MEDICAL GROUP PC (Chattanooga, TN)
    …clinical experience required. Minimum of two years of experience in Utilization Management, Case Management, or Care /Disease Management preferred. ... Level LPN License Job Shift Day Job Category Health Care Description Annual Wellness Visit Navigator I, LPN Galen...will work under the direction of the Population Health Manager to satisfy the EMR pre-population of upcoming Annual… more
    Upward (08/10/25)
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  • Sprenger Wellspring Silver Maple (Lorain, OH)
    …(RN) is responsible for planning, coordinating and documenting skilled professional nursing care provided to meet patient needs twenty-four (24) hours per day, seven ... and professional skills, the RN functions as a case manager and develops and implements a Home Health plan...and develops and implements a Home Health plan of care that meets each patient's specific needs and is… more
    Upward (07/31/25)
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  • GALEN MEDICAL GROUP PC (Hixson, TN)
    …Associates Degree Travel Percentage None Job Shift Day Job Category Health Care Description Medical Laboratory Technician Galen Medical Group offers several medical ... specialties throughout the Chattanooga region. We provide quality care and patient-friendly services to adults and children of all ages. Our mission is to elevate… more
    Upward (08/10/25)
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  • RN Utilization Manager - (Per Diem)…

    UNC Health Care (Smithfield, NC)
    …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance… more
    UNC Health Care (08/25/25)
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  • Senior Manager , Behavioral Health…

    Centene Corporation (Phoenix, AZ)
    …Tempe and/or Tucson offices.** **Position Purpose:** Manages the behavioral health (BH) utilization review clinicians to ensure appropriate care to members. ... Oversees and works with senior leadership on utilization management issues related to member care ,...+ LCSW- License Clinical Social Worker required or + LMHC- Licensed Mental Health Counselor required or + LPC- Licensed more
    Centene Corporation (09/14/25)
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  • Manager - Utilization Review…

    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** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you...care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely response to… more
    Beth Israel Lahey Health (07/29/25)
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  • Utilization Case Manager

    Helio Health Inc. (Syracuse, NY)
    …to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our ... Assist in developing and administering policies and procedures for utilization . + Negotiating access to care for...also take into account information provided by the hiring manager and program Job LocationsUS-NY-Syracuse Category Case/ Care more
    Helio Health Inc. (08/08/25)
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  • Manager , Utilization Review

    Children's Mercy Kansas City (Kansas City, MO)
    …nursing + required within 4 years of hire + 1-2 years experience + Experience in Utilization Review + One of the following: Licensed RN - MO, Registered Nurse ... and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient statusing… more
    Children's Mercy Kansas City (09/16/25)
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  • Manager , Utilization Management…

    CVS Health (Oklahoma City, OK)
    …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... do it all with heart, each and every day. **Position Summary** The Manager , UM Clinical Services, conducts oversight and management of clinical team processes… more
    CVS Health (09/06/25)
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  • Behavioral Health Care Manager

    Magellan Health Services (San Diego, CA)
    …that directly influence quality of care . General Job Information Title Behavioral Health Care Manager Remote, must be Licensed and Reside in California ... and substance abuse services provided in inpatient and/or outpatient care settings. Collects and analyzes utilization data....Maintains an active work load in accordance with National Care Manager performance standards. + Works with… more
    Magellan Health Services (08/14/25)
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  • LVN - Utilization Management - SRS…

    Sharp HealthCare (San Diego, CA)
    …setting. + 2 Years utilization /Case Management experience, preferably in a Managed Care setting. + Experience as a case manager or discharge planner ... by our recruitment and hiring teams. **What You Will Do** To provide comprehensive utilization management and coordination of care for SRS Members. Ensure timely… more
    Sharp HealthCare (09/17/25)
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  • Medical Director Utilization Management

    AmeriHealth Caritas (Philadelphia, PA)
    … Management provides organizational leadership in the operational areas of care management, utilization review, appeals, quality improvement and related ... and practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The following… more
    AmeriHealth Caritas (08/12/25)
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  • Clinical Manager , Behavioral Health (UM)…

    Magellan Health Services (Boise, ID)
    …supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive care management staff, providing ... for RN, Masters or Doctoral level provider. General Job Information Title Clinical Manager , Behavioral Health (UM) - Licensed , Remote in Idaho Grade 27 Work… more
    Magellan Health Services (08/26/25)
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  • Licensed Professional Mental Health…

    Veterans Affairs, Veterans Health Administration (Dayton, OH)
    …EDRP application. Former EDRP participants ineligible to apply. Responsibilities The Licensed Professional Mental Health Counselor (LPMHC) will coordinate and manage ... but not limited to, visits, referrals, patient demographics, equipment utilization and patient satisfaction. Develops, implements and evaluates clinical guidelines… more
    Veterans Affairs, Veterans Health Administration (09/06/25)
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  • Licensed Professional Mental Health…

    Veterans Affairs, Veterans Health Administration (Grand Junction, CO)
    …the EDRP application. Former EDRP participants ineligible to apply. Responsibilities The Licensed Professional Mental Health Counselor (LPMHC) Program Manager is ... of the REACH-VET Coordinator, who is an advanced practicing licensed social worker, and the REACH VET Nurse Case... social worker, and the REACH VET Nurse Case Manager , who is a registered nurse. Works with Mental… more
    Veterans Affairs, Veterans Health Administration (08/03/25)
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  • Licensed Store General Manager

    Pearle Vision (Columbus, OH)
    GENERAL FUNCTION: The major responsibility of the Store Manager is to drive profitable sales growth through the delivery of outstanding patient experience. Lead team ... in a positive and productive environment, modeling exemplary patient care . Develop and maintain outstanding associate and doctor satisfaction and retention. MAJOR… more
    Pearle Vision (08/29/25)
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  • Case Manager , RN or Licensed

    Excellus BlueCross BlueShield (Dewitt, NY)
    …and collaboration to ensure delivery of consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral ... program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and… more
    Excellus BlueCross BlueShield (08/28/25)
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