- Fallon Health (Worcester, MA)
- …strategic leadership and oversight responsibility for the clinical and operational utilization management activities for all inpatient and outpatient care, and staff ... across all product lines. **Responsibilities** ** Utilization Management:** + Oversees all administrative, operational and clinical functions related to outpatient… more
- CVS Health (Austin, TX)
- …+ Job Description Primary Job Duties & Responsibilities Drives effective utilization management practices by ensuring appropriate and cost-effective allocation of ... and facilitating appropriate healthcare services/benefits for members. Conducts routine utilization reviews and assessments, applying evidence-based criteria and clinical… more
- State of Michigan (Lansing, MI)
- Medicaid Utilization Analyst 12 - HSA Psychotropic Medication Oversight Unit (FC-PMOU) Print (https://www.governmentjobs.com/careers/michigan/jobs/newprint/5143934) ... Apply Medicaid Utilization Analyst 12 - HSA Psychotropic Medication Oversight Unit...visit our MDHHS Diversity, Equity, and Inclusion Plan. Medicaid Utilization Analyst 12 This position serves as the recognized… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 251119-5613FP-001 Location Middletown, CT Date Opened 12/11/2025 12:00:00 AM Salary ... Hospital (https://portal.ct.gov/dcf/solnit-center/south) - is accepting applications for a Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) (REGULATORY) position, located… more
- Centene Corporation (Sacramento, CA)
- …team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence ... to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues + Maintains… more
- New York State Civil Service (Bronx, NY)
- NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), Bronx Psychiatric Center, P27525 Occupational Category Health Care, ... 10461 Duties Description Bronx Psychiatric Center is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and efficiency… 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...directing key aspects of abdominal organ allocation, logistics, and utilization for transplantation and research. This role is accountable… 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 ... ensure compliance with utilization management policies. This role conducts admission and continued stay reviews, supports denials and appeals activities, and… more
- 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 onsite. ... position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include supervising… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …REVISED FTE *_SUMMARY:_* We are currently seeking a*Staff Nurse*to join our Utilization Management department for the/Emergency Department / This position is a*0.6 ... and may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the… more
- Huron Consulting Group (Chicago, IL)
- …expert you are now and create your future. The Manager of Utilization Management is responsible for planning, organizing, developing, and directing implementation of ... the Utilization Review Plan and the overall operation of the Utilization Management Department in accordance with federal, state and local guidelines, regulatory… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the CMHS. ... analyze data, and develop recommendations to resolve problems related to the appropriate utilization of patient care services at the appropriate level of care. +… more
- LifeCenter Northwest (Bellevue, WA)
- …Salary Position Type Full Time Description and Qualifications The Director, Organ Utilization (Director), is responsible for overseeing the processes and teams that ... and executes strategies to improve organ allocation strategy and organ utilization , collaborates closely with transplant programs and the surgical recovery team… more
- Community Health Systems (Naples, FL)
- Join us as a **Registered Nurse (RN) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is an onsite ... match & more available for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews hospital admissions, extended stays, and supporting… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + ... **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... with meeting the organization's goals and objectives for assuring the effective, efficient utilization of health care services. This role will be an expert on… more
- 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 and ... of the URN, this position is able to cover a multitude of utilization review functions through point of entry, observation progression of care management, concurrent… more
- UNC Health Care (Morrisville, NC)
- …unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible for ... designing, implementing, and standardizing utilization management functions across a large healthcare system, including a complex academic health system and multiple… 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, ... on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I ... comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're working… more
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