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Utilization Management Behavioral Health Professional
Humana Insurance Company
Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health knowledge and skills to support the coordination,…
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Utilization Management Nurse Consultant
Aetna Resources, LLC
Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare)
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Utilization Management Clinical Consultant - OhioRISE - must reside in Ohio
Aetna Medicaid Administrators
Utilize clinical expertise to coordinate, document, and communicate all aspects of the utilization management and benefit determination process.
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Registered Nurse Clinical Information Specialist
Banner Health Corporate
Join Banner Health's Utilization Review Department (BHURD) as a fully remote RN, where your acute bedside expertise will directly impact patient care across our entire health system. With a…
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Clinician, Clinical Response
About Us
The Clinical Response Clinician provides excellent clinical customer service, utilization management support, and operational guidance to members, families, providers, and internal teams.…
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Case Manager - Utilization Management
Lehigh Valley Hospital
Acts as a resource and educates on the appropriate level of care assignment, patient class, and utilization management-related work.
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Behavioral Health Service Mgr
Centene Management Company LLC
…health and clinical background, including experience with case management or utilization management, high-volume clinical reviews, medication monitoring, and medication management. This…
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Market Physician Executive - Pennsylvania
Monogram Health
Responsible for clinical outcomes to include, but not limited to, clinical interventions closure, inpatient/outpatient utilization, pharmacological prescribing and therapy management,…
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Register Nurse Utilization Review
Ascension
Champion regulatory and compliance standards across utilization management practices to safeguard quality care delivery and uphold federal and third-party payer guidelines.
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Wellness Health Coach - Behavioral Health
Centene Management Company LLC
…Outpatient Programs (IOP), Managed Care Behavioral Health Care Management, or Utilization Management. The ideal candidate will bring strong clinical expertise in conducting comprehensive…
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Wellness Health Coach - Behavioral Health
Centene Management Company LLC
…Outpatient Programs (IOP), Managed Care Behavioral Health Care Management, or Utilization Management. The ideal candidate will bring strong clinical expertise in conducting comprehensive…
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Case Manager - Utilization Review Specialist
Jobgether
Join a healthcare team dedicated to improving utilization management, strengthening reimbursement outcomes, and ensuring compliance with clinical and payer requirements. In this remote…
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Senior LTSS Service Care Manager (RN)
Centene Management Company LLC
Key Details: This is a hybrid position that includes home visits with members and remote work from home. Experience in RN care coordination or case management with adult members (21 or…
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Obstetric Overnight Triage RN
Pomelo Care
- Reducing care gaps (missed appointments, medication management, etc.) by frequent and personalized engagements with patient
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Utilization Management RN - Physical Health
Humana Insurance Company
The Utilization Management (UM) Nurse uses clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration…
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Lead Utilization Review Nurse (RN)
Medix Staffing Solutions
We are seeking an experienced and detail-oriented Lead Utilization Review Registered Nurse (RN) to perform daily medical necessity evaluations, manage denial workflows, and optimize revenue…
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Clinical Care Manager-RN (MA)
WellSense Health Plan
The Clinical Care Manager provides holistic clinical care management services for members across the continuum of care through comprehensive assessment, care planning, education, care…
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Telephonic Nurse Case Manager: FL RN License (Remote)
Davies
Provide telephonic case-management in a Workers’ Compensation environment. Focus on medical appropriateness of care to injured worker with cost savings by coordination and utilization of…
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Telephonic Nurse Case Manager: California RN License (Remote)
Davies
Provide telephonic case-management in a Workers’ Compensation environment. Focus on medical appropriateness of care to injured worker with cost savings by coordination and utilization of…
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UM Review Nurse
Astrana Health, Inc.
We are seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced setting.
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Oncology Nurse Practitioner - Aetna Oncology Care Team
CVS Health
This is a fully remote position. Eligible candidates may live anywhere in the contiguous United States.
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Manager- Quality & Acc.
WNS Global Services
Maintains expertise in utilization management workflows, policies, and operational processes to ensure meaningful oversight and auditing activities.
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Mgr-RN, Clinical Documentation, Quality, and Process Improvement
SSM Health Care Corporation
…regulatory compliance, policies and procedures and personnel…
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Care Manager RN - Utilization Management
Providence
Care Manager RN - REMOTE position. This position is Full time and will work 8- hour, Day shifts.
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Quality Assurance Specialist (QA RN) - Home Health
Bella Terra Home Health
Review visit utilization to ensure services align with patient condition, care guidelines, and reimbursement requirements