• Transition of Care Management - Registered…

    CVS Health (Springfield, IL)
    …meet the requirements of the position **Preferred Qualifications** + Certified Case Manager + 3+ years Care Management , Discharge Planning and/or Home Health ... TOC team will review prior claims to address potential impact on current case management and eligibility status. Assessments and/or questionnaires are designed… more
    CVS Health (01/01/26)
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  • Behavioral Health Nurse - Managed Care

    DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
    …clinical nursing experience, including behavioral/mental health + Experience in a managed care, case management , or utilization review setting + Strong ... on clinical guidelines and insurance coverage. + Provide telephonic and/or in-person case management and member education regarding conditions, medications, and… more
    DOCTORS HEALTHCARE PLANS, INC. (01/01/26)
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  • Management & Program Analyst

    Federal Communications Commission (Washington, DC)
    …agency objectives, justifies and defends resources requirements to senior level management , ensuring efficient utilization of allocated resources. Ensures ... and purchase card activities and projects; and reviews and prepares related management reports and other performance measures. Analyzes and evaluates controls to… more
    Federal Communications Commission (01/04/26)
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  • Outpatient Care Management RN

    Carle Health (Peoria, IL)
    …to improve access to care and achieve optimal clinical outcomes. Qualifications Certifications: Certified Case Manager within 2 years - Commission for Case ... bonus - External candidates with at least 1 year of experience The OP Care Management RN provides care management and population health services to patients. The… more
    Carle Health (01/01/26)
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  • Care Management Director

    UNC Health Care (Kinston, NC)
    … Manager provides efficient and effective delivery of patient care through case management process. Works toward desirable patient outcomes with MD, staff, ... family and patient involvement to enhance awareness of length of stay, resource utilization and principles of patient care. Functions on a highly interactive level,… more
    UNC Health Care (12/16/25)
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  • Nurse Clinical Care Coordinator -Allegheny County

    UPMC (Pittsburgh, PA)
    …clinical and social history, current medications, geriatric syndromes, healthcare resource utilization , and case management interventions. Updates the ... staff assigned to the geographic region of the care manager . Attends and participates in face-to-face case ...1 year of experience in clinical, utilization management , home care, discharge planning, and/or case … more
    UPMC (12/31/25)
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  • Mgr Comprehensive Care RN

    Baylor Scott & White Health (Temple, TX)
    …responsible for assessing and coordinating patient care across the continuum to include case management , social work, utilization review and care ... **JOB SUMMARY** Manager Comphrensive Care Management RN manages...ongoing problem solving related to care coordination, discharge planning, case management and utilization review.… more
    Baylor Scott & White Health (12/04/25)
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  • Chief Medical Officer, Health Plan (Based in AZ)

    Molina Healthcare (Chandler, AZ)
    … (CPHM), Certified Professional in Healthcare Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) ... the health plan in the development and execution of care management and utilization management programs. Develops clinical practice guidelines and oversees… more
    Molina Healthcare (12/24/25)
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  • Medical Management Clinician Senior (US)

    Elevance Health (Miami, FL)
    …in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and ... Med Management Clinician Senior- Licensed Nurse **Location:** Miami, FL...May collaborate with healthcare providers. Focuses on relatively complex case types that do not require the training or… more
    Elevance Health (12/24/25)
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  • Appeals RN - Care Management Full- time…

    Providence (Torrance, CA)
    …may considered (in lieu of acute care). + 2 years - Experience as a case manager in an acute care setting. **Preferred Qualifications:** + Bachelor's Degree - ... Nursing or, + Master's Degree - Nursing. + Case management certification upon hire. + Experience...time **Job Shift:** Day **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT CA SOCAL **Address:** CA Torrance 21311 Madrona… more
    Providence (01/07/26)
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