• Case Mgr, RN Casual- Case Management

    Northwell Health (Staten Island, NY)
    …care according to regulatory standards. * * Performs concurrent utilization management using Interqual criteria. * Conducts chart review for appropriateness ... management and clinical pathways, variance analysis and trending, quality management / utilization review and home care/discharge planning, preferred. *… more
    Northwell Health (10/21/25)
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  • Director of Clinical Review…

    St. Luke's Health System (Boise, ID)
    …Luke's is truly a great place to work. The **Director of Clinical Review Management ** provides strategic and operational leadership across multiple settings and ... operating units to lead the organization's utilization management function in support of SLHS...: City** _Boise_ **Category** _Nursing Leadership_ **Work Unit** _Clinical Review Management System Office_ **Position Type** _Full-Time_… more
    St. Luke's Health System (10/08/25)
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  • Senior Director Case Management

    Houston Methodist (Houston, TX)
    …oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for ... initiatives. + Provides strategic vision and execution for case management and utilization review across all hospitals and central departments. Establishes… more
    Houston Methodist (10/16/25)
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  • RN Case Manager - Care Management

    PeaceHealth (Vancouver, WA)
    …of stay consistent with external regulations and standards. + Provide utilization management including facilitating appropriate status assignment per Medicare ... management , quality assurance/quality improvement, clinical documentation and/or utilization management using Intensity Severity Discharge (ISD). (Preferred)… more
    PeaceHealth (10/23/25)
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  • Field Medical Director, Pain Management

    Evolent (Carson City, NV)
    …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent (09/25/25)
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  • Director Case Management

    Brockton Hospital (Brockton, MA)
    … management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience ... delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare… more
    Brockton Hospital (09/12/25)
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  • Clinical Reviewer

    Independent Health (Buffalo, NY)
    …credentials preferred. + Four (4) years of clinical experience required. Utilization Management experience preferred. + Comprehensive knowledge and experience ... The Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals as indicated in… more
    Independent Health (10/07/25)
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  • RN Acute Case Manager - System Care…

    Guthrie (Sayre, PA)
    …experience: five (5) years of experience in an acute care setting with strong care management , utilization review , and payer knowledge. A Case Management ... for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with other internal… more
    Guthrie (10/15/25)
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  • Physician Advisor Denials Management

    CommonSpirit Health (Englewood, CO)
    **Job Summary and Responsibilities** **Thi** **s is a remote position** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews ... to all constituents.** **Key Responsibilities** + Conducts medical record review in appropriate cases for medical necessity of inpatient...such as Joint Operating Committee (JOC), as requested by Utilization Management or Care Management .… more
    CommonSpirit Health (09/08/25)
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  • Psychologist Reviewer

    Centene Corporation (Indianapolis, IN)
    …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
    Centene Corporation (10/29/25)
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