• RN Care Coordinator

    Dignity Health (Glendale, CA)
    …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management more
    Dignity Health (11/19/25)
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  • Physician Advisor

    CommonSpirit Health (Salt Lake City, UT)
    …Leaders at the assigned sites. This position provides support to the facility Utilization Management Committees, medical staff, UM Hub, and care coordination ... manage/prevent denials, manage length of stay, meet licensure, compliance, quality and utilization management requirements to ensure optimal patient outcomes and… more
    CommonSpirit Health (11/07/25)
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  • Psychiatrist- Assistant Chief (Education Debt…

    Veterans Affairs, Veterans Health Administration (Battle Creek, MI)
    …other champions to improve processes to meet the performance measure goals and improve utilization management ; serving as a liaison to outside facilities when to ... Serves as a Mental Health leader for quality improvement initiatives and utilization management related to Psychiatry Service. Plans, coordinates and ensures… more
    Veterans Affairs, Veterans Health Administration (10/08/25)
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  • Medical Director - Medicaid (Oklahoma)

    CVS Health (Madison, WI)
    … Organization a Plus **Preferred Qualifications:** -Preferred Oklahoma residency -Health plan/payor Utilization Management / Review experience. -Managed Care ... the Aetna Better Health Plan of Oklahoma. This UM ( Utilization Management ) Medical Director will be a...Management , including prior authorization as well as concurrent review . Cases could focus on inpatient or outpatient services,… more
    CVS Health (12/19/25)
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  • Commercial Review Specialist I

    SUNY Upstate Medical University (Syracuse, NY)
    …Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, experience with ... with reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria to ensure patients are at the… more
    SUNY Upstate Medical University (11/18/25)
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  • Authorization Technician II (ALD)

    LA Care Health Plan (Los Angeles, CA)
    Authorization Technician II (ALD) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... achieve that purpose. Job Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and… more
    LA Care Health Plan (12/18/25)
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  • Physician - Physician Advisor

    Ascension Health (Jacksonville, FL)
    …of recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a ... of care and length of stay determination. + Assist and manage the denial management process. + Review and offer suggestions related to resources and service… more
    Ascension Health (11/12/25)
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  • Care Coord

    UnityPoint Health (Des Moines, IA)
    …to plan and execute a safe discharge + Collaborate with Utilization Management team on continued stay review . + Collaborates with patients, caregivers, ... continuity through elimination of fragmentation of care/service and facilitates the effective utilization of resources. Serves as educator and a central source of… more
    UnityPoint Health (10/17/25)
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  • Director of Quality

    HCA Healthcare (Sun City Center, FL)
    …Healthcare Quality) OR CHCQM (Diploma in American Board of Quality Assurance and Utilization Review Physicians). _Individuals without CPHQ or_ CHCQM _will be ... of experience in a healthcare environment + Previous experience in accreditation, quality, utilization management , or risk management required. + Knowledge… more
    HCA Healthcare (12/11/25)
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  • RN - Registered Nurse - Hospital Case Manager

    Geisinger (Lewistown, PA)
    …and efficiency results for assigned population. + Works to appropriately apply benefits and utilization management serving as a resource to the patient or member ... as part of a shared rotation. Don't worry, we'll review this in your interview. At least two (2)...have prior RN experience in a hospital setting. Case Management experience is preferred and not required. The successful… more
    Geisinger (11/05/25)
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