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Audit Manager
Jobgether
This leadership opportunity is designed for an experienced Registered Nurse with a strong background in utilization review, clinical investigations, and healthcare auditing. You will…
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Financial Clearance Rep I
Children's Hospital Medical Center
…Surgery, Outpatient Department, Patient Financial Services, Utilization Review and other Cincinnati Children's departments. Multiple division support; cross trained in order to work…
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Registered Nurse Clinical Information Specialist
Banner Health
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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RN Medical Reviewer II
Palmetto GBA
…protocol sets or clinical guidelines. Provides support and review of medical claims and utilization…
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Physician Reviewer
AltaMed Health Services Corp
The Physician Reviewer, Medical Management, provides a routine review of authorization requests from all lines of business using respective national/state health plans and nationally…
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Clinical Analyst
Color Employer, LLC
Draft, review, and maintain coverage criteria based on characteristics such as age,clinical presentation, and risk factors·
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Donor Assessment Coordinator
TransMedics, Inc.
…coordination with TransMedics partners, resulting in better utilization of donor…
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Donor Assessment Coordinator
TransMedics, Inc.
…coordination with TransMedics partners, resulting in better utilization of donor…
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Donor Assessment Coordinator
TransMedics, Inc.
…coordination with TransMedics partners, resulting in better utilization of donor…
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Clinical Investigator II
BMC Company 100
…control, or a comparable investigative role, case management, utilization review, or claims auditing; or equivalent combination of education and…
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Clinical Investigator II
BMC Company 100
…control, or a comparable investigative role, case management, utilization review, or claims auditing; or equivalent combination of education and…
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Senior Clinical Strategist - Aetna Payment Integrity – Ideation & Affordability
Aetna Resources, LLC
…and reimbursement changes, policy developments, healthcare utilization patterns, and industry intelligence into actionable Payment Integrity…
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Manager, Palliative Care (IKC)
RMD VillageHealth DM, LLC
Owns daily team operations, including referral management, patient prioritization, interdisciplinary case review, escalation pathways, documentation expectations, closed-loop communication,…
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Clinical Review Nurse - Prior Authorization
Centene Management Company LLC
Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care
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Clinical Review Nurse - Concurrent Review
Centene Management Company LLC
Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management…
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Nurse Specialist II
Qlarant
…have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with…
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Audit Manager
Arizona Department of Administration
…responsible for the direct oversight of the Quality Assurance Nurse Investigations Unit as a highly skilled Registered Nurse with Utilization Review (UR) experience. This individual will…
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Director of People & Culture
EXANTE360 INC
Implement talent review and succession planning frameworks.
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Clinical Quality Reviewer (Coder/Auditor)
CorroHealth Inc
…and technology partners. This position operates within a 24/7 review environment and plays a key role in supporting quality assurance initiatives and technology‑enabled clinical review…
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LPN Care Manager (Hybrid Remote) (Baldwin, Mobile & Washington Counties, AL)
AltaPointe Health
Conduct structured reviews of clinical records to assess service utilization, client engagement, and treatment plan compliance.
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RN - Clinical Supervisor
MGA Home Healthcare North Carolina LLC
Compliance and participation in the continuing quality improvement and utilization review of organizational services.
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Inpatient Review Nurse (LVN or RN)
Medix Staffing Solutions
Utilization Management Nurse (RN/LVN) – Inpatient Review
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Clinical Quality Assurance Coordinator (33133)
MES Solutions
…Assurance Coordinator. In this role, you’ll ensure our Peer Review case reports are nothing short of exceptional - delivering top-notch quality and integrity, all while staying fully…
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Clinical Quality Assurance Coordinator (33133)
IME RESOURCES LLC
…Assurance Coordinator. In this role, you’ll ensure our Peer Review case reports are nothing short of exceptional - delivering top-notch quality and integrity, all while staying fully…
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UM Operations Strategy Implementation Lead
CareSource Management Services LLC
The Utilization Management (UM) Operations Strategy & Implementation Lead is responsible for maintenance and oversight of all operational and compliance activities that support the UM…