- US Tech Solutions (Hopewell, NJ)
- …7. Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided. 8. Encourages member participation and ... of care. 11. Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes. 12. Evaluates care by problem… more
- Prime Healthcare (Inglewood, CA)
- …and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patients receive ... case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Additionally,… more
- US Tech Solutions (May, OK)
- …. Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT platforms/systems Skills: . MUST ... and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1 YEAR OF... management review. . MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. . MUST… more
- Hackensack Meridian Health (Hackensack, NJ)
- The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical records ... University Medical Center. These include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management, and transitions of… more
- CVS Health (Columbus, OH)
- …difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you'll play a ... phone, computer, etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Commitment to attend a… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Cottingham & Butler/ SISCO** 1 Positions ID: 4627707008 Posted On 07/01/2025 Refreshed On 11/23/2025 **Job Overview** ** Utilization ... Management Nurse** **Location** : Onsite in Dubuque, IA. Also accepting remote applicants. We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys making a difference for patients, and prefers working in a… more
- Elevance Health (Houston, TX)
- **Title: Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... employment, unless an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible for coordinating cases for… more
- CVS Health (Indianapolis, IN)
- …Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization . + Consult and lend expertise to other internal and external ... constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years of direct clinical… more
- Elevance Health (Walnut Creek, CA)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... 8:35 AM to 5:05 PM Pacific. Training hours may vary. The ** Utilization Management Representative I** is responsible for coordinating cases for precertification and… more
- South Middlesex Opportunity Council (Framingham, MA)
- …children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. Candidates must ... Working Conditions: As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact with clients… more