• Manager, Care Management

    Sutter Health (Burlingame, CA)
    …leading innovative case management programs. + 8 years experience in utilization management and discharge planning. + 8 years leadership experience in ... contact with the Administrative Team, Nurse Executives and Directors, Risk Management & Ethics staff, Ancillary Services, Revenue Cycle and Finance Department… more
    Sutter Health (10/22/25)
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  • Physician Advisor Clinical Appeals

    CommonSpirit Health (Englewood, CO)
    …tracking tools. The successful candidate will also collaborate cross-functionally with Utilization Management , CDI, coding, and compliance teams to reduce ... committee meetings, such as a Joint Operating Committee (JOC), as requested by Utilization Management or Managed Care: Works with the Care Management more
    CommonSpirit Health (09/28/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (WA)
    …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
    Molina Healthcare (10/24/25)
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  • Care Review Clinician (LVN / LPN)

    Molina Healthcare (Cedar Rapids, IA)
    …or emergency room. Previous experience in ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
    Molina Healthcare (10/22/25)
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  • RN Clinical Surgical Reviewer -SMH

    Ochsner Health (Slidell, LA)
    …operative, and postoperative data components for the Program through the effective utilization of the hospital medical record systems. + Responsible for the accurate ... Medical Records, and Information Systems Departments whose support is necessary for the management and success of the Program. + Adapts behavior to the specific… more
    Ochsner Health (08/21/25)
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  • Field Medical Director- (MD/DO)

    Evolent (Oklahoma City, OK)
    …**What You'll Be Doing:** As a FMD, Radiology 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 (09/26/25)
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  • Field Medical Director, Oncology

    Evolent (Helena, MT)
    …Doing:** As a Field Medical Director, Oncology, 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 (08/29/25)
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  • Behavioral Health Intake and Utilization

    Charter Care Health Partners (Providence, RI)
    Summary: The Behavioral Health Intake and Utilization Review Coordinator is responsible for bed management , reviewing intake assessments, verifying clinical ... appropriateness for services, coordinating admissions, and overseeing utilization review activities to ensure timely access to care and appropriate resource … more
    Charter Care Health Partners (10/21/25)
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  • Primary Therapist - Full Time

    Penn Medicine (Moorestown, NJ)
    …of pre-certifications as well as coordination of utilization reviews with utilization management reviewer . Timely and accurate completion of UM ... treatment, treatment plan development and coordination, referent relations, discharge planning, utilization management with insurance companies, and case … more
    Penn Medicine (10/25/25)
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  • Primary Therapist - Per Diem

    Penn Medicine (Eatontown, NJ)
    …of pre-certifications as well as coordination of utilization reviews with utilization management reviewer . Timely and accurate completion of UM ... treatment, treatment plan development and coordination, referent relations, discharge planning, utilization management with insurance companies, and case … more
    Penn Medicine (10/24/25)
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