- CVS Health (Austin, TX)
- …the department.** **Rotational late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical ... Clinical Social Worker (LCSW) preferred. + Requisition Job Description **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100%… more
- Katmai (Fort Carson, CO)
- …American Red Cross. + Three (3) years within the last four (4) years as a registered nurse in utilization management . + One (1) year of experience in UR/UM ... Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE...provisions within the catchment areas that affect the financial utilization of the Government by using professional nursing… more
- Centene Corporation (New York, NY)
- …Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages prior authorization, concurrent...standards **Education/Experience:** Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 5+ years of related… more
- Centene Corporation (Madison, WI)
- …Review 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
- Mount Sinai Health System (New York, NY)
- …**Program Director (Licensed)** is responsible for leading and sustaining a Utilization Management Initiative supporting ACO and value-based care populations. ... Occupational Therapy **Experience Requirements** + 7+ years of experience in care management , utilization management , population health, or value-based care.… 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 system, including a complex academic health system and… 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
- Alameda Health System (Oakland, CA)
- … Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + Posted:March ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...in Nursing Preferred Education: Master's degree in Nursing Required Experience: Three years of utilization … more
- CentraCare (St. Cloud, MN)
- …Utilization Management RN to join our team. In this pivotal role, the Utilization Management Nurse will play an integral part in determining the ... and more! Qualifications: + Bachelor's degree or higher in nursing required + Registered Nurse (RN) Current...issues required + Current working knowledge of discharge planning, utilization management , case management , performance… more
- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Jan 6, 2026 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career ... care and their communities. Role Overview: The role of Utilization Management Manager oversees the integration of...for this role will have a bachelor's degree in nursing , public administration, public policy, public health or related… more
- CVS Health (Austin, TX)
- …the department.** **Rotational late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical ... 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… more
- CVS Health (Baton Rouge, LA)
- …we do it all with heart, each and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical ... professionals to ensure the efficient, compliant, and high-quality delivery of utilization management processes. This leader supports organizational goals by… 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)
- …a meaningful 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 ... + Clinical experience in ER, ICU, or Critical Care preferred. + Managed Care/ Utilization Management experience. + Experience with Claims Review processes +… more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of federal,… more
- CVS Health (Harrisburg, PA)
- …Experience** + **3 or more years BH clinical Experience** + **1 or more years Utilization Management Experience** + **Work at Home role. Can live Anywhere USA** ... residence (LMSW, LCSW, LISW, LPC, or comparable) or Registered Nurse licensure with psychiatric specialty, certification, or experience in.... No weekends or holidays. + 1+ years of utilization review/ utilization management required. +… 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 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
- Intermountain Health (Las Vegas, NV)
- …including social work and complex care planning, transitions of care, and utilization management . The position ensures compliance with state, national, and ... + Demonstrated care management experience. + Authorization or Utilization Management experience. + Leadership experience. **Preferred Qualifications** +… more
- Rochester Regional Health (Rochester, NY)
- …class as needed. Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a resource on ... Job Title: Registered Nurse I Department: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time) Schedule: Monday -… more
- Highmark Health (Harrisburg, PA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... setting **Preferred** + Experience in UM/CM/QA/Managed Care + Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization Review experience… more
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