• Care Transitions Jobs

    Beth Israel Lahey Health (Plymouth, MA)
    …Hospital-Plymouth** is expanding its **Care Transitions Department** and seeking an experienced ** Manager of Utilization Review & Denials Management** and ** ... for level of care and continued stay * Lead appeals of clinical denials and collaborate with physician advisors...or other case management certification preferred or in progress ** Manager - Utilization Review & Denials Management**… more
    Beth Israel Lahey Health (10/30/25)
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  • Authorization Technician II (1 yr contract.…

    LA Care Health Plan (Los Angeles, CA)
    …II collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting ... Technician II (1 yr contract. weekends must)) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time… more
    LA Care Health Plan (11/04/25)
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  • Medical Review Nurse (RN)

    Molina Healthcare (Buffalo, NY)
    …modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Provides support for medical claim… more
    Molina Healthcare (10/18/25)
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  • Per Diem RN - Case Management - Sharp Grossmont…

    Sharp HealthCare (La Mesa, CA)
    …**Shift** Day **FTE** 0 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered ... position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving care… more
    Sharp HealthCare (09/06/25)
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  • Senior Medical Director - Sharp Health Plan…

    Sharp HealthCare (San Diego, CA)
    …to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager to identify ... needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its'...direction to the functions within the Medical Management Department ( Utilization /Cost Management and Quality Management) + Develops and updates… more
    Sharp HealthCare (10/18/25)
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  • Associate General Counsel - Carelon Services

    Elevance Health (Manchester, NH)
    …impacting Carelon Services businesses, including behavioral health, medical benefits utilization management, specialty care solutions, and care delivery companies. + ... preferred. + Expertise in legal and regulatory issues affecting utilization management activities, including prior authorization, medical necessity, clinical… more
    Elevance Health (10/30/25)
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  • Texas State Dental Director DHMO

    Guardian Life (Plano, TX)
    …as needed (eg Specialty Referral Guidelines) with guidance from the Quality and Utilization Management Manager . + Demonstrate expertise in QMP processes and ... with applicable state regulations. You will ensure that claims, referrals, appeals , and grievances meet state specific regulations, timeframes, and definitions for… more
    Guardian Life (10/21/25)
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  • National Accounts Medical Director

    Elevance Health (Overland Park, KS)
    …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
    Elevance Health (09/23/25)
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  • Administrative Assistant II / Emergency…

    The County of Los Angeles (Los Angeles, CA)
    …analysis, and making recommendations to line managers on matters such as: utilization of personnel; allocation of funds; workload and workload fluctuations; and ... work objectives. Work under general supervision of the line or division manager . Acceptable classes for Staff Capacity experienceMAY include but are not limited… more
    The County of Los Angeles (09/19/25)
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  • Family Health Advocate - Remote

    Sharecare (Albany, NY)
    …open enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or...Physical Therapy Assistant + Nursing Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide +… more
    Sharecare (10/14/25)
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