• Utilization Management Admissions…

    LA Care Health Plan (Los Angeles, CA)
    Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II...but not limited to: Skilled nursing facility, outpatient needs ( home health, physical therapy, infusion), and case management more
    LA Care Health Plan (10/03/25)
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  • Utilization Management Manager…

    CareFirst (Baltimore, MD)
    …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... expected to work a portion of their week from home and a portion of their week at a...medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care.… more
    CareFirst (10/11/25)
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  • Utilization Management - Behavioral…

    Humana (Charleston, WV)
    …put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional who utilizes behavioral health ... communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional work assignments are… more
    Humana (10/17/25)
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  • Utilization Management Reviewer

    AmeriHealth Caritas (Washington, DC)
    …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
    AmeriHealth Caritas (09/01/25)
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  • Manager, Utilization Review

    Children's Mercy Kansas City (Kansas City, MO)
    …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... To provide leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal management and development… more
    Children's Mercy Kansas City (09/16/25)
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  • Utilization Review RN

    BayCare Health System (Tampa, FL)
    …Occasional + **On Call:** No **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management ) + Preferred CCM (Case Manager) ... of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians.... Review or + Required 2 years in Case Management or + Required 3 years Registered Nurse more
    BayCare Health System (10/10/25)
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  • Home Based Primary Care Program Director…

    Veterans Affairs, Veterans Health Administration (Spokane, WA)
    …this occupational series. For more information, refer to Required Documents below. The Home Based Primary Care (HBPC) Program Director is accountable for the ... management , supervision and evaluation of care for patients enrolled...patients enrolled in the HBPC and other VA staffed in- home programs that are organizationally aligned under HBPC, which… more
    Veterans Affairs, Veterans Health Administration (10/10/25)
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  • Registered Nurse - Home Based…

    Veterans Affairs, Veterans Health Administration (Mcclellan, CA)
    utilization . Demonstrates leadership in delivering and improving holistic, home -based care through collaborative strategies with others. Evaluates practice in an ... Summary The Home Based Primary Care-Outpatient Staff RN assesses, plans,...for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care.… more
    Veterans Affairs, Veterans Health Administration (10/18/25)
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  • Registered Nurse - Home Based…

    Veterans Affairs, Veterans Health Administration (Bedford, MA)
    …this occupational series. For more information, refer to Required Documents below Registered Nurse - Outpatient Home Based Primary Care position is located at the ... 40 hours per week. Responsibilities VA offers a comprehensive total rewards package: VA Nurse Total Rewards The Home Based Primary Care (HBPC) Outpatient Staff… more
    Veterans Affairs, Veterans Health Administration (10/16/25)
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  • Registered Nurse - Home Based…

    Veterans Affairs, Veterans Health Administration (Bath, NY)
    …Responsibilities Duties may include however, are not limited to the following: The Nurse Home Based Primary Care (HBPC) Outpatient Staff Registered Nurse ... utilization . Demonstrates leadership in delivering and improving holistic, home -based care through collaborative strategies with others. Evaluates practice in an… more
    Veterans Affairs, Veterans Health Administration (10/16/25)
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