• Commonwealth Care Alliance (Boston, MA)
    013650 CCA-Auth & Utilization Mgmt - Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health ... quality team.collaboration with the broader clinical organization. - Ensures that utilization management processes are integrated with care management and care… more
    DirectEmployers Association (10/02/25)
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  • HealthCare Support (Houston, TX)
    Utilization Review RN HealthCare Support is actively seeking a Utilization Review RN to fill an opening with a Prestigious HealthCare Company in Remote Houston ... TX . Daily Responsibilities for Utilization Review RN: WIll need to use their OWN...7 am to 5pm Mon-Fri 8-5. Required Qualifications for Utilization Review RN: RN, current Texas License Three years… more
    Upward (08/09/25)
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  • Commonwealth Care Alliance (Boston, MA)
    013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for ... and facilities under the provisions of CCA's benefits plan. The Manager, Utilization Management is responsible for overseeing and managing the daily operation of… more
    DirectEmployers Association (10/02/25)
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  • Commonwealth Care Alliance (Boston, MA)
    013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS… more
    DirectEmployers Association (10/02/25)
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  • BroadPath Healthcare Solutions (Tucson, AZ)
    **Overview** BroadPath is seeking a highly motivated and results-oriented ** Utilization Management (UM) Nurse** . Our ideal **UM Nurse** will ensure timely review of ... + Minimum 3 years of experience in Managed Care, Provider Office, or Utilization Review organization required. + Knowledge of Commercial, Medicare, and Medi-Cal HMO… more
    DirectEmployers Association (09/13/25)
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  • ERP International (Macdill AFB, FL)
    …is seeking a **Registered** **Nurse (RN)** for a Full-Time position in ** Utilization Management** at MacDill AFB, FL. Apply online today and discover more ... about this exceptional employment opportunity. www.erpinternational.com **Be the Best!** Join our team of exceptional health care professionals across the nation. Come discover the immense pride and job satisfaction ERP Employees experience in providing care… more
    DirectEmployers Association (09/18/25)
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  • ERP International (Vandenberg AFB, CA)
    **Overview** ERP International is seeking a full-time **Registered Nurse (RN) Utilization Management** for a temporary contract position in support of the30th ... Medical Group at Vandenberg AFB, CA (https://www.airforcemedicine.af.mil/MTF/Vandenberg/About-Us/) . **NOTE: This is NOT a Tele-Health/Remote Practice Opportunity.** **Be the Best!** Join our team of exceptional health care professionals across the nation.… more
    DirectEmployers Association (09/13/25)
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  • Endeavor Health (Skokie, IL)
    …is responsible for the case management, care coordination management, and utilization management of his/her population of patients across multiple care levels ... length of stay optimization, reduction in excess days, reduction in SNF utilization and improvement in SNF care transitions, reduction in 30-day readmission rate… more
    Talent (10/25/25)
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  • Premera Blue Cross (Mountlake Terrace, WA)
    …in implementing and administering these programs along with supporting drug utilization management strategies and programs for Pharmacy, Medical Services, Care ... of business through research, analyses, and administration of clinical drug utilization management programs. + Provide clinical drug utilization management,… more
    DirectEmployers Association (10/21/25)
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  • Stanford Health Care (Palo Alto, CA)
    …include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness ... of services as well as appropriate utilization of services; and ensuring optimum use of resources,...team members; arranges follow up care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and retrospectively all… more
    DirectEmployers Association (08/21/25)
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  • Eisai, Inc (Nutley, NJ)
    …communication materials. The Director facilitates coverage, reimbursement and appropriate utilization based on generation and communication of quality data. ... patient needs to develop compelling value proposition that drives optimal access and utilization of Eisai marketed products in the United States.Provide input to the… more
    HireLifeScience (09/09/25)
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  • Houston Methodist Hospital (Houston, TX)
    …most clinically appropriate care to patients while promoting the most cost-effective utilization of the hospital's resources. The Director Case Mgmt Social Svcs ... providing excellent customer/patient service. Plays a leadership role in utilization review committee which includes identification of opportunities for appropriate… more
    Appcast IO CPA (08/19/25)
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  • Swedish Health Services (Tacoma, WA)
    …and external to the organization, to improve patient care through effective utilization and monitoring of healthcare resources and assumes a leadership role to ... provides oversight for the Case Management Associate for discharge planning and utilization activities *Coordination: Integrates the work of the healthcare team by… more
    Talent (10/28/25)
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  • Houston Methodist West Hospital (Houston, TX)
    …for services provided, as applicable. Uses resources efficiently to maximize utilization of time and equipment. Self-motivated to independently manage time ... Demonstrates professional and technical competence in the selection, evaluation, utilization of treatment plans for increasingly complex patient populations… more
    Appcast IO CPA (10/24/25)
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  • First Insight, Inc. (Pittsburgh, PA)
    …proactive monitoring of customer initiatives & challenges Proactive, strategic and expanding utilization to support account growth FI solution use is expanded and ... opportunities to integrate with customers tech stack to increase adoption, utilization , value realization, and ease of workflow Specific accountabilities include: Be… more
    Upward (08/10/25)
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  • Houston Methodist West Hospital (Houston, TX)
    …for services provided as applicable. Uses resources efficiently to maximize utilization of time and equipment. Self-motivated to independently manage time ... Demonstrates professional and technical competence in the selection, evaluation, utilization of treatment plans for increasingly complex patient populations… more
    Appcast IO CPA (10/14/25)
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  • Plante Moran (Denver, CO)
    …the office/region and department Collaborate with office leadership to achieve office utilization goals of staff and meet recommended industry group mix requirements ... Assist Talent Deployment Manager in reporting on and evaluating tax/assurance utilization (firmwide) Closely monitor assurance/tax staff hours and schedules Assist… more
    Upward (08/12/25)
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  • Centra Health, Inc (Lynchburg, VA)
    …resolution in an appropriate, timely and consistent manner. Resource Utilization and Stewardship - Supports organizational efforts regarding appropriate resource ... utilization (ie flexing during low census). - Serves as...specialty indicators and/or unit-based quality metrics. - Demonstrates the utilization of Centra's safety behaviors (ie Speak Up for… more
    Talent (10/25/25)
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  • Mom's Meals (Ankeny, IA)
    …and chronic care meals benefits at the partner account level, encouraging utilization through a variety of efforts, including communication of the value of ... benefit to partner objectives, removal of any operational barriers to utilization and quick resolution of any account issues to develop and maintain a high level of… more
    DirectEmployers Association (10/23/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …+ Lead the monitoring and analysis of provider performance using utilization , quality, and member experience metrics. + Collaborate with Business Intelligence, ... collaboratively with internal departments-including Clinical Operations, Contracting, Network Management, Utilization Management, and Business Intelligence-to align LTSS performance priorities… more
    DirectEmployers Association (10/17/25)
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