• Care Manager RN - Case Management

    Covenant Health (Lubbock, TX)
    …care environment. Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review , discharge planning, ... hire: Bachelor's Degree in Nursing. + 1 year of experience in care management or utilization review in any setting or successful completion of TIPS program… more
    Covenant Health (01/10/26)
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  • Remote Behavioral Medical Director

    Centene Corporation (Olympia, WA)
    …+ American Board certified in Child or Addiction Psychiatry, preferred + Utilization Management experience and knowledge of quality accreditation standards. + ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. +… more
    Centene Corporation (01/07/26)
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  • Medical Director

    Centene Corporation (New York, NY)
    …York + Board certified in Internal Medicine or Family Medicine preferred + Utilization Management experience and knowledge of quality accreditation standards. + ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. +… more
    Centene Corporation (01/06/26)
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  • Medical Management Specialist I

    Elevance Health (Tampa, FL)
    …Prepares reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation ... appropriate area to refer or assign case ( utilization management , case management , QI, Med Review ). Provides information regarding network providers… more
    Elevance Health (12/24/25)
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  • Medical Director, Medical Management

    Highmark Health (Tallahassee, FL)
    …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
    Highmark Health (11/21/25)
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  • Senior Director, Resource Management…

    BeOne Medicines (San Mateo, CA)
    …Resource Management will lead the end-to-end global budget & resource management / utilization within GCO including the development of the Annual Operating ... team on resource-related decisions, including prioritization, hiring, and FSP vendor utilization . + Lead cross-functional resource review forums to optimize… more
    BeOne Medicines (12/31/25)
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  • Care Management Tech

    Tenet Healthcare (Detroit, MI)
    …coverage, and appropriate provider. Performs input into various databases as appropriate for utilization management , LOS management and Denial Management ... Care Management Tech - 2506004272 Description : DMC Sinai-Grace...and general concerns regarding policies and procedures. Maintains necessary utilization review files for all patients in… more
    Tenet Healthcare (01/04/26)
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  • Medical Management Clinician Associate

    Elevance Health (Seattle, WA)
    …or equivalent. Requires a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... services in multiple states. **Preferred Skills, Capabilities and Experiences:** + Utilization Management and/ore Case Management experience strongly… more
    Elevance Health (01/13/26)
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  • Manager of Care Management - RN

    Community Health Systems (Naples, FL)
    …Management is responsible for the planning, coordination, and oversight of care management services, including utilization review , discharge planning, and ... efficiently, effectively, and in compliance with organizational standards. + Oversees utilization review and discharge planning processes to ensure… more
    Community Health Systems (11/22/25)
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  • RN Case Manager - Case Management

    Rady Children's Hospital San Diego (San Diego, CA)
    …Degree in Nursing 4 years nursing in an acute hospital or 2 years Case Management , Utilization Review , or Discharge Planning experience in an acute hospital ... coordinating discharge needs, quality of care, and implementing the utilization management process for acute inpatients. Case... process for acute inpatients. Case Managers perform concurrent review and denials management based on acute… more
    Rady Children's Hospital San Diego (12/21/25)
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