- Centene Corporation (Phoenix, AZ)
- …and/or Tucson offices.** **Position Purpose:** Manages the behavioral health (BH) utilization review clinicians to ensure appropriate care to members. Oversees and ... works with senior leadership on utilization management issues related to member care, provider interactions,...to member care, provider interactions, and facilitates operations within utilization management. + Oversees the behavioral health (BH) … more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Staff Nurse*to join our Utilization Management department for the/Emergency Department / This position is a*0.8 FTE (8 ... and may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the… more
- Centene Corporation (Sacramento, CA)
- …with prior auth is highly preferred** **Position Purpose:** Directs the utilization management team to ensure the appropriate application of policy procedures ... and processes to help support best member outcomes. Oversees and manages Utilization Operations specific to the daily operations of Utilization Management… more
- Beth Israel Lahey Health (Boston, MA)
- …lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status ... of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for… more
- Ventura County (Ventura, CA)
- Per Diem Registered Nurse II/III - Utilization Management VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply Per Diem ... Registered Nurse II/III - Utilization Management VCMC Salary $109,727.64 - $184,627.89 Annually Location...as needed to assist with patient care coordination and utilization review. The incumbent will be responsible to assist… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review, the Utilization Review Medical Director will be responsible ... for providing leadership and subject matter expertise to our utilization management (UM) group. This role is a key role in helping our organization provide high… more
- CommonSpirit Health (Phoenix, AZ)
- **Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is charged 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 matters regarding… 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
- Centene Corporation (Columbus, OH)
- …STATE OF OHIO IDEAL CANDIDATE WILL HAVE PRIOR AUTHORIZAION OR UTILIZATION MANAGEMENT EXPERIENCE PEOPLE LEADER EXPERIENCE STRONGLY PREFERRED **Position Purpose:** ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence… 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
- 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: *Manages ... the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include supervising staff performing … more
- LifeCenter Northwest (Bellevue, WA)
- Organ Utilization Coordinator Job Details Job Location Bellevue HQ - Bellevue, WA Position Type Full Time Salary Range $75918.00 - $110112.00 Salary Job Posting ... Date(s) Start Date 08/05/2025 Description and Qualifications The Organ Utilization Coordinator (OUC) is accountable for overseeing all activities related to the… 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
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR ... direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the… more
- Molina Healthcare (San Diego, CA)
- …Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management activities ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more
- Catholic Health Services (Melville, NY)
- …was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help facilitate ... utilization management and appeals functions to include coordination of...payment related activities. Position Responsibilities: Prepares necessary documentation for utilization management and appeals processes, performs data management and… more
- UNC Health Care (Smithfield, NC)
- …episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance with… more
- UnityPoint Health (Cedar Rapids, IA)
- …S + Shift: 40 Hours Per Week + Job ID: 168048 Overview The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a key ... coordinating the department's interdisciplinary effort to assess and promote appropriate utilization of health care resources, provision of high-quality health care,… more
- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Aug 22, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career with ... services, health care and their communities. Role Overview: The role of Utilization Management Manager oversees the integration of utilization review, clinically… more
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