- New York State Civil Service (Syracuse, NY)
- NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), Hutchings Psychiatric Center, P26038 Occupational Category Health ... Code 13210 Duties Description Hutchings Psychiatric Center is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical...+ Staff Acquisition and Support: Leads and manages the utilization review staff and function for the… more
- LifeCenter Northwest (Bellevue, WA)
- …Position Type Full Time Description and Qualifications The Manager, Organ Utilization (OUM) provides strategic leadership and operational oversight for the Organ ... Utilization Coordinator Team (OUCT), directing key aspects of abdominal...maintain compliant, high-quality processes. + Monitor donor case workflows, review allocation strategies, and ensure documentation aligns with regulatory… more
- Katmai (Fort Carson, CO)
- …access to care standards for appropriate utilization of services. Perform utilization management/ review for medical necessity for specialty referrals and ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization...Working knowledge of EHR Genesis desirable. + Knowledge of Medical Terminology. **WORK** **SCHEDULE** Full-time. May be required to… more
- CVS Health (Austin, TX)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... influence stakeholders and networks of healthcare professionals by promoting effective utilization management strategies. Reviews and analyzes medical records,… more
- CVS Health (Austin, TX)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... occasionally per the need of the department.** **Rotational late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you… 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 purpose ... Utilization Management Manager Date Posted: Jan 6, 2026...paid to thousands of service providers ranging from major medical centers to a physical therapist working with a… more
- Humana (Little Rock, AR)
- …and integrated care needs for those with autism + Prior experience with Utilization Review , Utilization Management, Peer Reviews and/or Quality Management ... and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization … more
- CVS Health (Baton Rouge, LA)
- …Responsibilities** + Lead, coach, and develop a multidisciplinary team responsible for utilization review , prior authorization, and case management functions. + ... do it all with heart, each and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical professionals to… more
- Humana (Jackson, MS)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization … more
- CVS Health (Phoenix, AZ)
- …thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services. + ... + Clinical experience in ER, ICU, or Critical Care preferred. + Managed Care/ Utilization Management experience. + Experience with Claims Review processes +… more
- Waystar (Atlanta, GA)
- …end user adoption of best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as an integral contributor in ... **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer...Excellent oral and written communication skills + Ability to travel 20-50% of the time, to domestic locations for… more
- Intermountain Health (Las Vegas, NV)
- …Care Management I leads and collaborates with care management operations across utilization review , acute and emergency department care, and ambulatory/community ... Qualifications** + Previous management experience in hospital care management, utilization review , ambulatory care management, ambulatory utilization… more
- Humana (Tallahassee, FL)
- …conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization , and identifying unusual ... Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format**… more
- CareFirst (Baltimore, MD)
- …accreditation standards and federal/state regulations and general principles relating to utilization review . + Computer skills, including Microsoft Office ... & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of health… more
- Highmark Health (Bismarck, ND)
- …determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update ... prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical...At times, the incumbent may conduct additional research beyond medical policy review to make coverage determinations.… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …as assigned UM/Cost Protection * Accountabilities include the overall value of utilization management (UM) product, medical and reimbursement policies, and ... Shield of Minnesota Position Title: Senior Director of Health Services - Utilization Management Location: Hybrid | Eagan, Minnesota Career Area: Health Services… more
- Katmai (Usaf Academy, CO)
- …need for inpatient/outpatient precertification. **ESSENTIAL DUTIES & RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- US Tech Solutions (Columbia, SC)
- …Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for ... appeals requests using Medicare criteria. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by… more
- Ventura County (Ventura, CA)
- …+ Experience with managed care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs + At ... care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review ...Review systems and programs + Direct patient care medical practice experience + Administrative experience + National Committee… more
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