- University Health (Boerne, TX)
- …patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff , clinic leadership, and outside agencies in an effort ... years recent, full time hospital experience preferred. Work experience in case management , utilization review, or hospital quality assurance experience is… more
- University Health (Hondo, TX)
- …years of clinical nursing experience is required. Data entry, referral management , utilization management experience is required. Case Management ... patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff , clinic leadership, and outside agencies in an effort… more
- University Health (Pleasanton, TX)
- …Three years recent, full-time hospital experience preferred. Work experience in case management , utilization review or hospital quality assurance experience is ... appropriate for the services needed to be rendered. This position requires assertive clinical acumen and communication skills for serving in the liaison roles with… more
- Sunrise Senior Living (Charlottesville, VA)
- …listed as follows: Clinical Care Delivery Operations * Directs, supervises the management of the team members in the skilled nursing center. * Implements and ... management position within a skilled nursing environment including hiring staff , coaching, performance management daily operations supervision, discipline and… more
- Christus Health (Noonday, TX)
- …information effectively in verbal and written communication. Works well with all clinical disciplines and staff of all CHRISTUS facilities. Participates in ... as well as network transmission. Assists with the development and utilization of operating standards, policies, procedures, and industry best practices related… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Excellus BlueCross BlueShield (Rochester, NY)
- … Management Department clinical staff . Acts as resource to Utilization Management staff , members and providers. + Provides backup for the ... if called upon, works directly with the operation and clinical staff to resolve issues and escalated...Bachelors degree preferred. + Minimum of three years of clinical experience required. Utilization Management … more
- UNC Health Care (Goldsboro, NC)
- …Medical Staff Services, Medical Staff Performance Improvement, Utilization Management , Clinical Documentation and Medical Student Affairs. ... the hospital and for providing leadership to the Medical Staff from a medical management perspective. The...care and patient outcomes. a. Oversees hospital and Medical Staff clinical practices and performance improvement initiatives.… more
- Community Health Systems (Franklin, TN)
- …Documents all utilization review activities in the hospital's case management software, including clinical reviews, escalations, avoidable days, payer ... . + Serves as a key contact for facility staff and insurance representatives regarding utilization review...+ 2-4 years of clinical experience in utilization review, case management , or acute care… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- **12/2/2025 - REVISED FTE *_SUMMARY:_* We are currently seeking a* Staff Nurse*to join our Utilization Management department for the/Emergency Department / ... utilization and controlling costs./**/ *Assessment:* * Collects, reviews, and documents clinical data relevant to utilization management , including… more
- CommonSpirit Health (Phoenix, AZ)
- …contribute to high-level organizational decision-making, working closely with other executives and clinical leaders to align utilization management practices ... **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of...guidance and mentoring to UM team members, including physicians, clinical staff , and administrative staff .… more
- UNC Health Care (Morrisville, NC)
- …chairs, hospital leadership, and finance teams to harmonize utilization management practices, ensuring alignment with clinical and financial objectives. ... the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible… 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. ... and the TRICARE Operations Manual (TOM) access to care standards for appropriate utilization of services. Perform utilization management /review for medical… more
- Houston Methodist (Houston, TX)
- …of hospital clinical nursing experience, which includes three years in utilization review and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + ... acute care indicators and criteria as approved by medical staff , payer guidelines, CMS, and other state agencies. In...to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of… more
- Tenet Healthcare (Detroit, MI)
- …potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements ... national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention… more
- State of Indiana (Indianapolis, IN)
- …three (3) years of staff management and evaluation experience; clinical experience in managed care and accredited utilization management experience ... This role provides direct supervision for one or more staff members. The ideal candidate for this role will...provides the skills needed to conduct oversight of all utilization management practices and clinical … more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- McLaren Health Care (Port Huron, MI)
- …with an acute care hospital **Preferred:** ⦁ Experience in utilization management /case management , critical care, clinical documentation, or patient ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- LifeCenter Northwest (Bellevue, WA)
- …teams as needed. + Serve as a clinical resource for Organ Utilization Coordinator Team (OUCT) and Organ Optimization staff , offering guidance on allocation ... Lead ongoing training and development initiatives for the OUCT and other clinical staff , ensuring mastery of core competencies and operational standards.… more
