• Utilization Management

    Elevance Health (Louisville, KY)
    ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... unless an accommodation is granted as required by law._ " The ** Utilization Management Representative II** is responsible for managing incoming calls,… more
    Elevance Health (08/19/25)
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  • Utilization Management

    Elevance Health (FL)
    ** Utilization Management Representative I** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required ... Friday, an 8-hour shift between 8 am - 8 pm EST. The ** Utilization Management Representative I** is responsible for coordinating cases for precertification… more
    Elevance Health (08/20/25)
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  • Utilization Management

    Elevance Health (Cincinnati, OH)
    ** Utilization Management Representative II** **Schedule: Monday-Friday 8am-5pm Eastern Time** **Must be located near one of our Ohio PulsePoint offices in ... benefits and/or eligibility information. + May act as liaison between Medical Management and internal departments. + Responds to telephone and written inquiries from… more
    Elevance Health (08/19/25)
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  • 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 ... service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role...Physical Requirements: * The physical demands described here are representative of those that must be met by an… more
    Commonwealth Care Alliance (07/31/25)
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  • Utilization Review Nurse Supervisor I

    The County of Los Angeles (Los Angeles, CA)
    UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply  UTILIZATION REVIEW NURSE SUPERVISOR I ... comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're working… more
    The County of Los Angeles (08/18/25)
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  • Board Certified Behavioral Analyst…

    Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
    …Oversee and direct work activities of unlicensed clinical staff involved in the utilization management process. + Communicate with ABA providers to gather ... policies. + Participate in the development and refinement of utilization management protocols and clinical review tools....behavioral health settings. _The Physical Demands described here are representative of those that must be met by an… more
    Blue Cross and Blue Shield of Louisiana (08/16/25)
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  • Sr Informatics Analyst (Pharmacy) - Fulltime…

    Henry Ford Health System (Troy, MI)
    …well as proponent of the proficiency, abilities and interests of representative department. Develop competency of various corporate databases and establish expertise ... requirements. Minimum 3 years experience in healthcare industry in reporting, data management or analysis. Two or more years experience with relational databases and… more
    Henry Ford Health System (08/20/25)
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  • Director of Contracts and Utilization

    Ochsner Health (Jefferson, LA)
    …job negotiates contracts, maintains high contract compliance, and manages supply utilization for their book of business. Drives cost redirection initiatives ... product change, and serves as an internal advocate of product standardization/ utilization initiatives. Assists with coordinating new product introduction and overall… more
    Ochsner Health (07/31/25)
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  • Behavioral Health Utilization Reviewer

    Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
    …and/or service decisions. + Document clinical decisions and rationale in the utilization management system. + Communicate determinations to providers and members ... records and case management systems _The Physical Demands described here are representative of those that must be met by an employee to successfully perform the… more
    Blue Cross and Blue Shield of Louisiana (08/16/25)
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  • RN Utilization Manager - REMOTE

    Ochsner Health (New Orleans, LA)
    …as well as efficiently in high pressure situations. Preferred- Experience in Case Management or Utilization Review Business and Financial Knowledge as well as ... each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations… more
    Ochsner Health (08/15/25)
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