• Valero (San Antonio, TX)
    …the energy industry and our community. As a*Data Center Engineering Specialist ,*you will provide engineering design and support for electrical systems, Heating, ... the data center. * Provide management, monitoring, and optimization of power utilization , HVAC requirements and capacity planning for Valero data center. * Provide… more
    DirectEmployers Association (09/05/25)
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  • Stanford Health Care (Palo Alto, CA)
    …one (1) year of experience as a licensed advanced practice provider: ( Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered ... provides clinical direction and education, works closely with operational and physician leaders, and has oversight of hiring, termination, and professional growth… more
    DirectEmployers Association (11/13/25)
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  • Stanford Health Care (Palo Alto, CA)
    …one (1) year of experience as a licensed advanced practice provider: ( Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered ... Provides clinical direction and education, works closely with operational and physician leaders, and has oversight of hiring, termination, and professional growth… more
    DirectEmployers Association (11/04/25)
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  • Katmai (Fort Carson, CO)
    …procedures, treatments and medications are administered in accordance with (IAW) physician orders, sound nursing judgment and applicable guidelines. + Accurately ... all levels of health care management to include outside agencies. Performs utilization management activities to optimize cost, quality, and access to care. Adhere… more
    DirectEmployers Association (09/13/25)
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  • Physician Utilization Review

    Hackensack Meridian Health (Hackensack, NJ)
    **The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
    Hackensack Meridian Health (11/12/25)
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  • Utilization Review Specialist

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry ... this position is able to cover a multitude of utilization review functions through point of entry,...process improvements). **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with the physician and all members of the interprofessional health care… more
    Houston Methodist (11/02/25)
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  • Utilization Review Specialist

    CaroMont Health (Gastonia, NC)
    …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case Management preferred. Minimum… more
    CaroMont Health (10/11/25)
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  • RN Utilization Review

    HonorHealth (AZ)
    …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
    HonorHealth (11/04/25)
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  • Utilization Review Specialist

    Medical Center Hospital (Odessa, TX)
    + Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician Advisors. + Qualifications: A. Education: Holds a current Texas… more
    Medical Center Hospital (10/18/25)
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  • Utilization Review Specialist

    Hunterdon Health Care System (Flemington, NJ)
    This is an in-person role. Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
    Hunterdon Health Care System (10/31/25)
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  • Utilization Management Specialist II

    AnMed Health (Anderson, SC)
    …necessity review , continued stay/concurrent review , retrospective review , bed status management, resource utilization management, regulatory compliance, ... assigned utilization management functions daily: initial, concurrent and retrospective review of the medical record with speed and accuracy for all required… more
    AnMed Health (11/13/25)
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  • Manager - Utilization Review

    Minnesota Visiting Nurse Agency (Minneapolis, MN)
    *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work ... this position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include… more
    Minnesota Visiting Nurse Agency (09/30/25)
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  • Utilization Review Denials Nurse

    UNC Health Care (Kinston, NC)
    …support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established ... dollars and appeal win rates. 12. Assists in documentation review in the clinical documentation specialist role...experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
    UNC Health Care (11/20/25)
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  • Medicaid Utilization Analyst 12 - HSA…

    State of Michigan (Lansing, MI)
    …To identify psychotropic medication regimens that require additional physician review according to policy, the Utilization Reviewer actively monitors ... to identify foster care individuals with psychotropic medication regimens that require additional physician review , preparing the physician review more
    State of Michigan (11/20/25)
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  • Commercial Review Specialist I

    SUNY Upstate Medical University (Syracuse, NY)
    …including PC, Windows, Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, ... Job Summary: The UR-CR Specialist I is primarily responsible for ensuring that...reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria… more
    SUNY Upstate Medical University (11/18/25)
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  • Pharmacy Clinical Review Specialist

    UPMC (Bridgeville, PA)
    UPMC Rx Partners is looking for a full time Pharmacy Clinical Review Specialist to join their dedicated team! This position provides prescription data entry and ... provides customer service to Rx Partners Skilled nursing and Hospice clients. The clinical review specialist at Rx Partners works hand in hand with a licensed… more
    UPMC (10/30/25)
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  • Provider Solutions Specialist

    HCA Healthcare (Asheville, NC)
    …and personal growth, we encourage you to apply for our Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates ... We care like family! Jump-start your career as a Provider Solutions Specialist today with Mission Hospital. **Benefits** Mission Hospital offers a total rewards… more
    HCA Healthcare (11/16/25)
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  • Provider Solutions Specialist

    HCA Healthcare (Gainesville, FL)
    …and personal growth, we encourage you to apply for our Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates ... **Introduction** Do you have the career opportunities as a(an) Provider Solutions Specialist you want with your current employer? We have an exciting opportunity… more
    HCA Healthcare (11/12/25)
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  • Senior Provider Solutions Specialist

    HCA Healthcare (Kansas City, MO)
    …facilitates access review audits. + Tracks, monitors, and enhances provider utilization of HCA technologies, by offering at the elbow support and one-on-one ... to join an organization that invests in you as a(an) Senior Provider Solutions Specialist ? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300… more
    HCA Healthcare (10/29/25)
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  • Physician Advisor

    Mohawk Valley Health System (Utica, NY)
    … regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
    Mohawk Valley Health System (10/07/25)
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