• Onsite Care Management Supervisor (Hybrid)

    CareFirst (Baltimore, MD)
    … Supervisor will direct and coordinate the activities of Onsite Care Management staff, Onsite Clinical Navigators and/or other Registered Nursing roles ... FUNCTIONS:** + Provides direct onsite supervision, mentorship and support to care management staff, clinical navigators and other CareFirst nursing staff working… more
    CareFirst (10/14/25)
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  • Utilization Management Reviewer

    AmeriHealth Caritas (Washington, DC)
    …facilitate timely authorizations and optimize patient care + Analyze medical records and clinical data to ensure compliance with regulatory and payer guidelines ... **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring… more
    AmeriHealth Caritas (11/20/25)
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  • Manager, Risk Management - Healthcare

    Community Health Systems (Tucson, AZ)
    …**Licenses & Certifications** + **Preferred:** CPHRM (Certified Professional in Healthcare Risk Management ) and/or ARM ( Associate in Risk Management ). + ... The Manager of Risk Management provides leadership and expertise in developing, implementing,...an immediate impact. The Manager partners with hospital leadership, clinical teams, and legal and compliance departments to identify,… more
    Community Health Systems (10/29/25)
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  • Registered Nurse-Quality Management…

    Veterans Affairs, Veterans Health Administration (Miami, FL)
    …Miami VA medical center is recruiting for a Registered Nurse- Quality Management Specialist within Sterile Processing Service. The Registered Nurse- (QMS) functions ... responsibilities that demonstrate leadership, experience, and creative approaches to management of complex patient care. Assesses, plans, implements, and evaluates… more
    Veterans Affairs, Veterans Health Administration (12/17/25)
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  • Senior Medical Management Nurse - VCHCP

    Ventura County (Ventura, CA)
    … management responsibilities. + Experience related to HEDIS, including data collection, reporting, and ensuring compliance with HEDIS measures and standards. ... Senior Medical Management Nurse - VCHCP Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5113983) Apply ...An educational Incentive of 2.5% for completion of an associate 's degree, 3.5% for completion of a bachelor's degree,… more
    Ventura County (12/07/25)
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  • Utilization Management Supervisor (Hybrid)

    CareFirst (Baltimore, MD)
    …(all benefits/incentives are subject to eligibility requirements). **Department** Clinical Utilization Management **Equal Employment Opportunity** CareFirst ... Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of health… more
    CareFirst (11/22/25)
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  • Manager, Prior Authorization Utilization…

    CVS Health (Baton Rouge, LA)
    …of clinical experience + 3 years' experience in utilization management , prior authorization experience preferred + Demonstrated leadership experience in a ... it all with heart, each and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical professionals… more
    CVS Health (12/21/25)
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  • Health Information Management Analyst

    Stony Brook University (Commack, NY)
    …informatics. Prior experience in Health Information Management . Project management experience. Proficiency with data and spreadsheets. Experience performing ... Health Information Management Analyst **Required Qualifications (as evidenced by the...**Job Number:** 2504222 **Official Job Title:** : Project Staff Associate **Job Field** : Administrative & Professional (non- Clinical… more
    Stony Brook University (12/10/25)
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  • Director, Risk Management

    CenterWell (Indianapolis, IN)
    …and help us put health first** The Director, Home Health Risk Management identifies and analyzes potential sources of risk, proactively ensuring controls and ... are in place to reduce risk. The Director, Home Health Risk Management requires an in-depth understanding of how organization capabilities interrelate across the… more
    CenterWell (12/19/25)
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  • Risk Management Specialist

    Northern Light Health (Portland, ME)
    …The incumbent is responsible for the development and ongoing review of hospital-wide clinical risk and claims management . The incumbent will assist the Director ... Schedule: 8:00 AM to 4:30 PM Summary: The Risk Management Specialist works under the general supervision of the...patient safety committees and work groups and provides requested data associated with such groups. + Manages the Risk… more
    Northern Light Health (12/02/25)
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