• Transitional Care Manager, Behavioral Health

    CVS Health (Oklahoma City, OK)
    …and timely discharge, appropriate follow-up care, and next steps. + Coordinate with the Utilization Management team to review medical and payer records to ... observation stay through a clinical assessment and medical record review . + Triage to determine appropriate follow-up care and...stay and identify any barriers to discharge. + Assist Utilization Management team with access to external… more
    CVS Health (10/22/25)
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  • Case Manager RN

    Bassett Healthcare (Cooperstown, NY)
    …timely and accurate information to payors. The role integrates and coordinates utilization management , care facilitation, and discharge planning functions. The ... efficient delivery of care in appropriate setting. + Completes utilization management and quality screening for assigned...both areas. + Refers cases and issues to Case Review , Utilization Committee, Medical Director, and Director… more
    Bassett Healthcare (10/21/25)
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  • Field Medical Director - Vascular Surgery

    Evolent (Sacramento, CA)
    …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
    Evolent (10/10/25)
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  • Field Medical Director, Cardiology

    Evolent (Tallahassee, FL)
    …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
    Evolent (10/01/25)
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  • Nurse Case Manager - per diem

    Beth Israel Lahey Health (Cambridge, MA)
    …Description:** **Primary Responsibilities** (including but not limited to): 1. Performs utilization review and discharge planning to inpatient admissions to ... Inpatient criteria approved by the MACIPA (risk) and MAH (non-risk) Utilization Management Committees to accurately determine appropriateness for inpatient… more
    Beth Israel Lahey Health (08/13/25)
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  • Referral Management Reviewers (Bethesda,…

    Ivyhill Technologies LLC (Bethesda, MD)
    …an Associate's Degree and a minimum of 2 years of experience in Utilization Management , Referral Management , Authorization/Denials, or Medical Claims ... to non-network providers to TRICARE Service Center for medical necessity/appropriateness review . + Routinely monitors referral management voicemail to ensure… more
    Ivyhill Technologies LLC (09/08/25)
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  • Health Information Management (HIM)…

    City and County of San Francisco (San Francisco, CA)
    …timely coding and compliance with regulatory requirements in coordination with Utilization Management , Patient Financial Services, and Revenue Integrity. + ... and direction for multiple clinic-wide functions within the Health Information Management (HIM) - Mid Revenue Cycle Department, overseeing key functions that… more
    City and County of San Francisco (10/11/25)
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  • Medical Director, Behavioral Health (TX/WA)

    Molina Healthcare (UT)
    …**Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental ... management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization management and case management ...all LOBs * Responds to BH-related RFP sections and review BH portions of state contracts * Assist the… more
    Molina Healthcare (10/18/25)
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  • Chief Medical Officer

    HCA Healthcare (Port St. Lucie, FL)
    …issues. Offers clinical support for appeals and denials process, discharge planning, case management , and utilization review / management . + Consults with ... of quality and cost improvement and develops systems to review utilization of resources and objectively measure...facility-level staff regarding delegated utilization management and disease management operations under managed… more
    HCA Healthcare (10/16/25)
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  • SRS - Case Manager - Population Health -Copley…

    Sharp HealthCare (San Diego, CA)
    …skills in area of expertise. + Proficient knowledge and understanding of utilization management , case management , healthcare finances, alternative care ... clinical experience in area of specialty. + 2 Years Utilization /Case Management experience, preferably in a Managed...the first 12 hours of data to complete admission review .Documents assessment and IQ/guideline review data per… more
    Sharp HealthCare (10/24/25)
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