• RN Case Manager - Barnes-Jewish West County…

    BJC HealthCare (St. Louis, MO)
    …through the grounds and connects to Millennium Park. Care Coordination consist of Case Management , Social Services and Utilization Review . The personnel in ... to identify and resolve issues. Performs and provides consultation regarding Utilization Management and Performance Improvement programs in order to… more
    BJC HealthCare (01/03/26)
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  • Clinical Care Coordinator

    Kaleida Health (Williamsville, NY)
    …plans/care paths are addressed and met. Serve as liaison to ancillary and utilization review services, serve as communication link between health team members. ... planning, case management and home care required. Knowledge of Utilization Management . Use of computer applications related to health care industry as well… more
    Kaleida Health (12/31/25)
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  • Care Manager - Registered Nurse

    Crouse Hospital (Syracuse, NY)
    …of hospital resources while maintaining the quality of care. + Participates in the utilization management process using standards of care to determine the most ... Coordination Services team is hiring a Care Manager to review the services delivered to patients and compare it...- Five (5) years acute hospital experience. + Case Management or Utilization Management experience… more
    Crouse Hospital (12/31/25)
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  • Regional VP, Health Services

    Humana (Tallahassee, FL)
    …health initiatives. + Collaborate with various operational functions in the centralized utilization management team and other shared services. + Participate in ... data (eg Quality measures, Risk Adjustment ratings, chronic condition management , PCP visit rates and effectiveness, and member engagement...quality governance, peer review , and grievance resolution processes. Innovation & Transformation: +… more
    Humana (12/31/25)
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  • Social Worker- LCSW & Bilingual Preferred!

    ChenMed (Tampa, FL)
    …+ LCSWs will manage complex behavioral health patient issues by providing casework, utilization management and discharge planning services to promote the highest ... patients to improve coordination of services and information flow. + Provides self- management support and ongoing phone contact with patients. + Coordinates, reviews… more
    ChenMed (12/31/25)
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  • Integrated Outpatient Senior Clinician

    FLACRA (Penn Yan, NY)
    …progress notes and other documentation required for the client medical record and utilization management within the timelines outlined by FLACRA. + Participates ... + Monitors, support, and mentors clinicians in their practice management to meet expectations for excellent client care. +...in quality initiatives and utilization review activities as requested. + Strives… more
    FLACRA (12/11/25)
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  • Senior Manager, MN Clinical Ops - Oncology

    Cedars-Sinai (Los Angeles, CA)
    …the Foundation, including patient assignment, risk and specialty network structures, and utilization management . Functions as key resource for staff and ... and managing of assigned areas. Works closely with leadership and physician management in the centralized infrastructure development and operations for a specific… more
    Cedars-Sinai (12/06/25)
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  • Physician Opportunity

    Summit Medical Consultants LLC (Pueblo, CO)
    …care, and actively participates in medical staff duties. Participates in quality assurance, utilization management , and peer review programs to ensure high ... Supports practice budgetary targets while maintaining standards of care. Participates in utilization and care management processes to ensure high quality,… more
    Summit Medical Consultants LLC (12/01/25)
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  • Intensive Community Manager, Complex Care (RN)

    ChenMed (Cleveland, OH)
    …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The incumbent in ... assist in achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from admission through… more
    ChenMed (12/04/25)
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  • Director, Lab Stewardship and Test Optimization

    Bon Secours Mercy Health (Cincinnati, OH)
    …cost per test for both in-house and referral tests. + Develop and chair a utilization management review committee and partner with the prior authorization ... team. + Review high-cost and high-volume referral tests for clinical appropriateness...and problem-solving skills. + Excellent communication, collaboration, and project management skills. + Proven ability to influence physician behavior… more
    Bon Secours Mercy Health (12/13/25)
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