- HCA Healthcare - Chief Medical Officer (Bradenton, FL)
- …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... ongoing in-service programs to facility medical staff regarding clinical resource management , appropriate documents standards, utilization and quality issues,… more
- Monogram Health (Fort Myers, FL)
- …populations Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management , and risk adjustment Current state medical ... and the seamless transitions to dialysis, pre-emptive kidney transplant, conservative management . The Regional Medical Executive is a key clinical leader within… more
- Alameda Health System (San Leandro, CA)
- Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management + San Leandro, CA + John George Psychiatric Hospital + JGP Care Coordination + ... System) and Behavioral Health Department Alameda County Utilization Review Plan to obtain authorization of...EHR. 17. Maintains current knowledge of clinical practice and Utilization Management by literature review ,… more
- CVS Health (Phoenix, AZ)
- …partial hospitalization and intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior ... promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this… more
- Point32Health (MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the supervision of the Utilization Management Supervisor, the Behavioral Health (BH) ... and care management principles. Health Plan experience performing utilization review activities. Experience with McKesson's InterQual Clinical Screening… more
- Elevance Health (Indianapolis, IN)
- …a clinical call center The **Manager Behavioral Health Services** is responsible for Behavioral Health Utilization Management (BH UM), or Behavioral ... cost of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues....and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of… more
- UnityPoint Health (Cedar Rapids, IA)
- …ID: 174223 Overview This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient ... patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to...State of Iowa Licensed RN + Two years of behavioral health work experience. + Professional communication - written… more
- Immigration and Customs Enforcement (Washington, DC)
- …Perform other duties and responsibilities as assigned. 16. Utilization review / management for inpatient behavioral health hospitalization for IHSC. ... services include and are not limited to the following: case coordination/ management , monitoring high risk individuals, independent behavioral health reviews,… more
- Spectrum Billing Solutions (Skokie, IL)
- …Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist | ... Review Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health… 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...the Medical Director for further review . The reviewer independently applies medical and behavioral health… more
- Molina Healthcare (AZ)
- …most effective setting while contributing to enterprise-wide strategies for integrated behavioral health programs, utilization management standardization, ... + Provides psychiatric leadership and clinical expertise for utilization management , case management , and integrated behavioral health/chemical… 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 ... use 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… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Active clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care environment (as a clinician or in ... of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical...to evaluate clinical service requests + Practice anticipatory case management for members whose cases come for review… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Coordination Specialist provides administrative support for any of the programs of Utilization Management , Behavioral Health, Quality Management , ... and review timeliness, workflow volumes, referrals generated to care management programs + Provides administrative support to the grievance and appeals process… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management - 2506004107 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered ... for case management scope of services including: Utilization Management services supporting medical necessity and...level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 251212-5613FP-001 Location East Hartford, CT Date Opened 12/16/2025 12:00:00 AM ... to learn more about joining our team as a Utilization Review Nurse Coordinator! The State of...types of case reviews for quality and appropriate medical management , cost containment, peer review and rehabilitation;… more
- Behavioral Center of Michigan (Warren, MI)
- …and reporting of complex clinical data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's ... Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation… more
- Devereux Advanced Behavioral Health (Viera, FL)
- **Description** Are you looking to advance your career in Admissions & Utilization Review ? If you answered yes, then consider joining our team where you can take ... your career to the next level. **Being the Utilization Review Coordinator at Devereux has its...Devereux has its Advantages!** Devereux Florida is a nonprofit behavioral health organization that provides a wide range of… more
- CVS Health (Frankfort, KY)
- …with heart, each and every day. **Position Summary** This is a fully **remote** Utilization Review Clinical Consultant. **Must reside in the state of Kentucky or ... the standard schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Foster Care population experience +… more
- CVS Health (Austin, TX)
- …is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + Strong ... + Job Description Primary Job Duties & Responsibilities Drives effective utilization management practices by ensuring appropriate and cost-effective allocation… more
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