- Humana (Little Rock, AR)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …in UR/UM practices, payer requirements, clinical guidelines, and regulations affecting utilization management * Professional Practice*: * Evaluates personal ... - REVISED FTE *_SUMMARY:_* We are currently seeking a*Staff Nurse*to join our Utilization Management department for the/Emergency Department / This position is… more
- St. Peters Health (Helena, MT)
- …a collaborative and supportive liaison and educator to providers and staff around utilization management principles. This professional role will be ... The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN supports the UR RN Coordinator and other UR team members in… more
- Humana (Tallahassee, FL)
- …holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting ... our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity… more
- Covenant Health Inc. (Knoxville, TN)
- …as applicable. + Performs well on internal audits thus promoting a culture of professional expertise in utilization management . + Provides monitoring and ... Overview Registered Nurse Utilization Management PRN/OCC,Hours Vary, Day Shifts...as applicable. + Establishes effective rapport with other employees, professional support service staff, payors, patients, families and physicians.… more
- Katmai (Usaf Academy, CO)
- …**DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in Healthcare Management ... (BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered… more
- Aspirus Ironwood Hospital (Wausau, WI)
- … Professional in Healthcare Quality (CPHQ), Certified Case Manager (CCM), Certified Professional Utilization Management (CPUM), Certified Professional ... health care administration, or nursing. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + A minimum of five years of… more
- Centene Corporation (Austin, TX)
- …to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... everything for our 28 million members as a clinical professional on our Medical Management /Health Services team....performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH… 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
- 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 ... everything for our 28 million members as a clinical professional on our Medical Management /Health Services team....facilitates operations within utilization management . + Manages prior authorization, concurrent… 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
- Centene Corporation (Richmond, VA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… 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 CMHS. ... and the TRICARE Operations Manual (TOM) access to care standards for appropriate utilization of services. Perform utilization management /review for medical… more
- UNC Health Care (Raleigh, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... case management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization management… 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
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention ... potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements and… 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 ... social services, health care and their communities. Role Overview: The role of Utilization Management Manager oversees the integration of utilization review,… more
- Alameda Health System (San Leandro, CA)
- …EHR. 17. Maintains current knowledge of clinical practice and Utilization Management by literature review, membership in a professional organization. 18. ... Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management + San Leandro, CA + John George Psychiatric Hospital + JGP Care Coordination +… more
- Cleveland Clinic (Cleveland, OH)
- …in the world. As a Concurrent Denial Nurse, you will support the Utilization Management Department by reviewing concurrent and retrospective clinical inpatient ... Registered Nurse who is a subject matter expert in utilization management , has experience with MCG criteria,...be able to work well under pressure and maintain professional demeanor under adverse conditions **Personal Protective Equipment:** +… more