- Integra Partners (Troy, MI)
- …experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a ... Medical Director to perform benefit and medical necessity reviews and appeals within an NCQA-compliant UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS:… more
- McLaren Health Care (Port Huron, MI)
- …as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate ... or order entry for timeliness, appropriateness and completeness as pertains to the utilization management process including level of care, medical necessity, and… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 251212-5613FP-001 Location East Hartford, CT Date Opened 12/16/2025 12:00:00 AM ... to learn more about joining our team as a Utilization Review Nurse Coordinator! The State of...types of case reviews for quality and appropriate medical management , cost containment, peer review and rehabilitation; + Implement… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- **12/2/2025 - REVISED FTE *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department for the/Emergency Department / ... *Assessment:* * Collects, reviews, and documents clinical data relevant to utilization management , including patient status, treatment plans, and healthcare… more
- UNC Health Care (Kinston, NC)
- …applied clinical experience as a Registered Nurse required. + 2 years utilization review, care management , or compliance experience preferred. + Minimum 1 ... support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established… more
- Sanford Health (Rapid City, SD)
- …providing direct supervision of all departmental staff. Maintains a standardization of utilization management process to ensure all policies and procedures are ... Full time **Weekly Hours:** 40.00 **Department Details** Join our team as a Utilization Review and Case Management Manager and lead a high-impact, data-driven… more
- Huron Consulting Group (Chicago, IL)
- …the expert you are now and create your future. The Manager of Utilization Management is responsible for planning, organizing, developing, and directing ... Review Plan and the overall operation of the Utilization Management Department in accordance with federal,...Performance Tracking and Improvement: Provides analysis and reports of utilization , denials, and appeals KPIs, trends, patterns,… more
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** +… more
- US Tech Solutions (Columbia, SC)
- …team works with multiple applications to process authorization and appeals requests using Medicare criteria. **Responsibilities:** + Reviews and evaluates ... established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to… more
- Actalent (Rancho Cordova, CA)
- Utilization Review Nurse About the Role...2-3 years of clinical experience in prior authorization, case management , or utilization management + ... We're looking for a Utilization Review (UR) Nurse to join our team and support high‑quality, cost‑effective patient care from a fully remote environment. This… more