- Centene Corporation (Madison, WI)
- … 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 +… more
- 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… more
- UNC Health Care (Morrisville, NC)
- …the 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...Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate… more
- CVS Health (Austin, TX)
- …+ Job Description Primary Job Duties & Responsibilities Drives effective utilization management practices by ensuring appropriate and cost-effective allocation ... efficient use of healthcare resources. Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the ... care standards for appropriate utilization of services. Perform utilization management / review for medical necessity for specialty referrals and… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… more
- CentraCare (St. Cloud, MN)
- …You will be responsible to conduct key components of the St Cloud Hospital Care Management and Utilization Review (UR) plans which includes activities to ... St. Cloud Hospital is seeking a dynamic and experienced Utilization Management RN to join our team....in any of the following functions: utilization review , performance improvement, quality assurance, risk management … 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 ... Utilization Management Manager Date Posted: Jan... Utilization Management Manager Date Posted: Jan 6, 2026 Requisition...high quality care and services. You serve as the utilization management subject-matter expert in health care… more
- CVS Health (Austin, TX)
- …And we do it all with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can ... department.** **Rotational late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to… more
- AmeriHealth Caritas (Washington, DC)
- …meet the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of ... **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity...cases are escalated to the Medical Director for further review . The reviewer independently applies medical and… more
- CVS Health (Baton Rouge, LA)
- …Lead, coach, and develop a multidisciplinary team responsible for utilization review , prior authorization, and case management functions. + Monitor team ... we do it all with heart, each and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical… more
- Humana (Frankfort, KY)
- …analysis and integrated care needs for those with autism + Prior experience with Utilization Review , Utilization Management , Peer Reviews and/or Quality ... caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes...appropriate treatment, care, or services for ACD participants. + Review ABA TPs for policy compliance + Review… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer Success Organization who will provide clinical ... best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as...acute care setting + 2+ years of experience in utilization management + Knowledge and understanding of… more
- CVS Health (Phoenix, AZ)
- …in ER, ICU, or Critical Care preferred. + Managed Care/ Utilization Management experience. + Experience with Claims Review processes + Demonstrate making ... difference in the lives of patients? Join Mercy Care as a Utilization Management Clinical Consultant and become part of a mission-driven team that's transforming… more
- CVS Health (Harrisburg, PA)
- …work Monday through Friday 8:30-5pm . No weekends or holidays. + 1+ years of utilization review / utilization management required. + 3+ years of behavioral ... **3 or more years BH clinical Experience** + **1 or more years Utilization Management Experience** + **Work at Home role. Can live Anywhere USA** +… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating care for members ... of the member's benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer is part of a highly dedicated and motivated team of… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Intermountain Health (Las Vegas, NV)
- …The Manager of Care Management I leads and collaborates with care management operations across utilization review , acute and emergency department care, ... Qualifications** + Previous management experience in hospital care management , utilization review , ambulatory care management , ambulatory … more
- Highmark Health (Harrisburg, PA)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... UM/CM/QA/Managed Care + Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization Review... Utilization Management (UM) or (UR) Utilization Review experience **LICENSES AND CERTIFICATIONS** **Required**… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse I Department: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time) Schedule: Monday - ... Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a...with minimum direction. + Act as a resource for utilization review stakeholders and assists team members… more
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