- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.Thisis a full-time role. *Purpose of this position: ... ) required or completed within three years of hire **Title:** * Utilization Review Manager * **Location:** *MN-Minneapolis-Downtown Campus* **Requisition… 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** **Who ... Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- Virtua Health (Pennsauken, NJ)
- …UR Tech and AA to support UR and revenue cycle process.Position Responsibilities: Utilization Management* Utilizes Payer specific screening tools as a resource to ... resource group and payers.Documentation* Appropriate and complete documentation of clinical review and denial management in the case management documentation system… more
- Mayo Clinic (Rochester, MN)
- …workers, physicians and multi-disciplinary teams. Major Functions of the RN Case Manager include: Utilization Review , including concurrent admission status ... to work well within a creative and challenging work environment. Experience in utilization review , ability to navigate medical records, value based purchasing… more
- Behavioral Center of Michigan (Warren, MI)
- …skills to help educate the staff and physicians regarding charting. REPORTS TO: Utilization Review Lead/ Manager QUALIFICATIONS: + High School Diploma or ... Under general supervision, the Utilization Review Coordinator provides professional assessment,...those duties include all tasks requested by the UR Manager , CEO or Medical Director to meet the needs… more
- State of Indiana (Indianapolis, IN)
- …role of Utilization Management Manager oversees the integration of utilization review , clinically appropriate care and risk management for the purpose of ... Utilization Management Manager Date Posted: Aug 22, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career… more
- Beth Israel Lahey Health (Plymouth, MA)
- …Hospital-Plymouth** is expanding its **Care Transitions Department** and seeking an experienced ** Manager of Utilization Review & Denials Management** and ... + CCM, ACM, or other case management certification preferred or in progress ** Manager - Utilization Review & Denials Management** This role is ideal for a… more
- UPMC (Pittsburgh, PA)
- …given to candidates located in Pennsylvania. The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services ... is looking for you! We are hiring a full-time Utilization Management Care Manager to support the...information obtained from interaction with members and providers. + Review and document clinical information from health care providers… more
- Penn Medicine (Philadelphia, PA)
- …+ Registered Nurse - PA (Required) + 5yrs prior experience as a Nurse Case Manager with knowledge of utilization review and 3rd Party Payors (Required) ... Experience: * And 5+ years Prior experience as a nurse case manager with knowledge of utilization review and third-party payors. We believe that the best… more
- Ochsner Health (Lafayette, LA)
- …Registered Nurse license in state of practice. Preferred - Commission for Case Manager (CCM), Certified Professional Utilization Review (CPUR), Certified ... by the physician and applies hospital approved medical necessity criteria to review appropriate admissions and levels of care. Documents completed reviews in the… more
- Nuvance Health (Sharon, CT)
- …to restore health to the patient. Responsibilities for this full time RN Case Manager position includes include utilization review , discharge planning and ... care transitions. Candidates require a CT state RN license, Bachelors Degree in Nursing or related field, a minimum of 1 year Case Management experience in an acute care setting. CCM, PRI and Screen certifications preferred. Mon thru Fri 8a-430p, Every other… more
- University of Utah Health (Salt Lake City, UT)
- …the accurate reporting of time and attendance of direct reports. + Functions as Case Manager and/or Utilization Review Nurse as necessary. + Tracks and ... analyzes Case Manager quality of service and utilization statistics. + Works collaboratively with information systems personnel as needed to implement case… more
- CVS Health (Oklahoma City, OK)
- …delivery field as a psychiatrist. * Experience with managed care, as a provider and manager of care utilization review or physician advisor experience. * ... Health), you will: * Provide leadership and day-to-day physician oversight for utilization management team, including the management of high-risk cases and medical… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital...Compact State Licensure required + CCM - Certified Case Manager preferred or + Accredited Case Manager … more
- University of Miami (Miami, FL)
- …Department of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. The incumbent ... retrospective chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare team for… more
- UNC Health Care (Smithfield, NC)
- …care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management ... needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
- 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. ... within utilization management. + Oversees the behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines +… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
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