• Utilization Management Reviewer

    Commonwealth Care Alliance (Boston, MA)
    …procedures, and facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical ... and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role in ensuring CCA meets CMS… more
    Commonwealth Care Alliance (07/31/25)
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  • Utilization Management Review Nurse

    AmeriHealth Caritas (LA)
    …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...home healthcare or a medical office setting. + Previous prior authorization experience is required.; + Proficiency in Electronic… more
    AmeriHealth Caritas (06/25/25)
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  • Staff Utilization Coordinator

    University of Utah Health (Salt Lake City, UT)
    … to reassign staff based on census and workload, adhering to the Nurse Utilization Policy. + Assist Hospital Supervisor and Nursing Leadership in identifying ... and trust that are integral to our mission. EO/AA_ The Staff Utilization Coordinator is responsible for providing healthcare operational support services, including… more
    University of Utah Health (08/07/25)
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  • LPN Supervisor , Care Review Prior

    Molina Healthcare (Tacoma, WA)
    …+ Oversees an integrated Care Access and Monitoring team responsible for prior authorizations and/or other utilization management activities aimed ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
    Molina Healthcare (08/08/25)
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  • RN Supervisor UM Prior Auth

    Dignity Health (Rancho Cordova, CA)
    …Summary:** Under the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable ... sets (Medicare Guidelines InterQual Health Plan Benefit Interpretation Guidelines and Medical Management Policies and DHMF Utilization Management guidelines… more
    Dignity Health (06/20/25)
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  • Case Management Supervisor

    State of Massachusetts (Boston, MA)
    …staff and hospital-wide teams. * Ensure timely and accurate dissemination of utilization management data across departments and maintain compliance with evolving ... **Medical Services* **Organization:** **Department of Public Health* **Title:** *Case Management Supervisor * **Location:** *Massachusetts-Boston-170 Morton Street* **Requisition… more
    State of Massachusetts (08/09/25)
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  • RN Supervisor Case Management - Full…

    Mohawk Valley Health System (Utica, NY)
    RN Supervisor Case Management - Full Time - Days Department: CARE MANAGEMENT SERVICES Job Summary The Supervisor Case Management - SNH is responsible ... for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include the supervision and… more
    Mohawk Valley Health System (07/09/25)
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  • Supervisor of Case Management

    Ellis Medicine (Schenectady, NY)
    + The Supervisor of Case Management and Social Work (CMSW) assists with the daily operations of the Department. This person can assist with the hiring and ... of stay (LOS) and cost per case through resource management . + The Supervisor of CMSWS is...CMSWS assist with providing the link between compliance, clinical management , patient progression, gathering and reporting of utilization more
    Ellis Medicine (05/13/25)
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  • Supervisor , Care Review (RN)

    Molina Healthcare (Milwaukee, WI)
    …Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
    Molina Healthcare (07/27/25)
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  • Supervisor Care Management

    AdventHealth (Shawnee, KS)
    …at our hospital in Shawnee Mission, Kansas. **The role you'll contribute:** The Care Management Supervisor is under the general leadership of the Care ... operations and supervision of team members in the Care Management department. The Care Management Supervisor...action plans + Balances schedules to meet department needs prior to posting + Communicates changes to expected schedule… more
    AdventHealth (08/07/25)
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