• Manager, Utilization Review

    Children's Mercy Kansas City (Kansas City, MO)
    …development of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
    Children's Mercy Kansas City (12/15/25)
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  • Physician Advisor

    Catholic Health Initiatives (Lexington, KY)
    …and quality. Participates in suggested training sessions. + Participates in the Case Management Process including Utilization Review and Proactive Discharge ... for daily availability for rounds and / or other daily case management and utilization review activities. Ensures that physicians covering the PA are… more
    Catholic Health Initiatives (12/25/25)
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  • Penn Medicine Physician Advisor

    Penn Medicine (Philadelphia, PA)
    …a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and the hospital ... documentation and payer requirements. * Facilitate, mentor, and educate case management on the utilization review process where appropriate * Chair, or… more
    Penn Medicine (12/06/25)
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  • Quality Management Nurse Consultant

    US Tech Solutions (RI)
    …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... **Job Description:** + Responsible for the review and evaluation of clinical information and documentation....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE… more
    US Tech Solutions (10/17/25)
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  • Middle Revenue Cycle Clinical Supervisor

    Catholic Health (Buffalo, NY)
    …Care Hospital Setting + Minimum five (5) years of experience working within Utilization Review /Case Management /Clinical Documentation Integrity or + Minimum ... Cycle and interdisciplinary care team and works in conjunction with the Utilization Review Manager and Manager Clinical Documentation Integrity. The Middle… more
    Catholic Health (12/31/25)
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  • Physician Reviewer (Behavioral Health)

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …Active clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care environment (as a clinician or in ... of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical...to evaluate clinical service requests + Practice anticipatory case management for members whose cases come for review more
    Blue Cross Blue Shield of Massachusetts (11/25/25)
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  • System Physician Advisor

    CommonSpirit Health (Englewood, CO)
    **Job Summary and Responsibilities** **This is a remote position** As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews ... of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations regarding level… more
    CommonSpirit Health (11/26/25)
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  • SLH Care Management Specialist

    Alameda Health System (San Leandro, CA)
    …specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post ... Experience: Three years in a health care field or one year in Utilization Management at a Medical Group or Health plan experience; electronic Health Record (EHR)… more
    Alameda Health System (12/31/25)
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  • VP Care Management Post-Acute Care…

    Kaleida Health (Buffalo, NY)
    …In addition to daily oversight of operations, the VP will partner with Utilization Review , Revenue Cycle, and Clinical leadership to create patient/family ... Business field preferred. RN licensure required.** **Experience** **10 years of care management / utilization management experience required in hospital and/or… more
    Kaleida Health (12/17/25)
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  • Director Care Management - RN

    Community Health Systems (Hattiesburg, MS)
    …4-6 years of clinical nursing experience required + 3-5 years of experience in care management or utilization review required + 1-3 years of leadership ... + Refers cases not meeting criteria to the Physician Advisor or Utilization Management Committee and ensures appropriate follow-up. + Identifies avoidable… more
    Community Health Systems (12/10/25)
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