• Pre-Service Coordinator

    Humana (Miramar, FL)
    …referral source and provider interactions and communications. Work with Pre-Authorization, Utilization Management , Billing, Pharmacy, Home Care and DME regarding ... follow established procedures for approving request or referring request for further review . Provide referral management education to members and providers… more
    Humana (12/24/25)
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  • Human Geography (HG) Analyst

    Leidos (St. Louis, MO)
    …ArcGIS Pro software tools in the creation, attribution, schema development and utilization , management , and geo-referencing of data. + Experience in geo-enabling ... + Utilize an understanding of geography, research, GIS, and data conflation and management skills to produce a broad array of human geography products including… more
    Leidos (01/09/26)
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  • Grievances and Appeals Corporate Medical Director

    Humana (Frankfort, KY)
    …and interpretation skills with prior experience leading teams focusing on quality management , utilization management , discharge planning and/or home health ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Advises executives to develop… more
    Humana (01/01/26)
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  • Consultant Pharmacist

    Polaris Pharmacy Services, LLC (Lebanon, OH)
    …savings using preferred drug management and formulary compliance, perform review of controlled substance utilization , reconciliation, and documentation; ... reports of these reviews, providing quarterly reports reflecting facility-level drug utilization and clinical management trends, recommendations to improve… more
    Polaris Pharmacy Services, LLC (12/23/25)
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  • Behavioral Health Care Manager II - ABA

    Elevance Health (Las Vegas, NV)
    …or certification is a requirement for this position. + Previous experience in case management / utilization management with a broad range of experience with ... , offers superior clinical mental health and substance use disorder management , a comprehensive employee assistance program, work/life support, specialty programs… more
    Elevance Health (01/09/26)
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  • Audiologist

    Luke Staffing (Fort Bragg, NC)
    …+ Comply with regulatory, MTF, and Joint Commission quality inspection/ peer review / utilization management requirements, and applicable system applications. ... and treatment, bio-electric implanted devices, advanced vestibular assessment and treatment/ management , and amplification and signal processing technology. In diagnosing… more
    Luke Staffing (01/09/26)
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  • Dir of Care Coordination/MDS - Nurse required

    Diversicare Healthcare Services & Diversicare Ther (Bryson City, NC)
    …**Qualifications** 1. Degree in nursing. 2. Knowledge of healthcare reimbursement, utilization management , and discharge planning. 3. Experience providing ... in and facilitate Engage/72 HR Admission meetings as part of the care management system. + Manage the restorative nursing program, integrating it with the activity… more
    Diversicare Healthcare Services & Diversicare Ther (01/07/26)
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  • Healthcare Subject Matter Expert - Payer

    CGI Technologies and Solutions, Inc. (Canton, MA)
    …workflows across key functions such as claims, provider operations, member services, utilization management , care management , and finance. Ideal candidate ... accurate representation of roles, decisions, systems, compliance checkpoints, and exceptions. * Review and refine process maps, SIPOCs, and metadata for accuracy and… more
    CGI Technologies and Solutions, Inc. (01/07/26)
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  • RNAC / Director of Care Coordination (RN)

    Diversicare Healthcare Services & Diversicare Ther (Hartford, AL)
    …Degree in nursing 2. RN License 3. Knowledge of healthcare reimbursement, utilization management , and discharge planning. 4. Experience providing strategic ... in and facilitate Engage/72 HR Admission meetings as part of the care management system. + Manage the restorative nursing program, integrating it with the activity… more
    Diversicare Healthcare Services & Diversicare Ther (01/05/26)
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  • RN Clinical Associate

    BAYADA Home Health Care (Morristown, NJ)
    …+ Management and mentoring of Clinical Associates and field staff + Utilization Management + Developing and mentoring staff to become strong case managers ... assurance teams + Orientation of field staff + Documentation review + Managing staff productivity + Leading team to...+ A current New Jersey RN license. + Strong management and leadership experience. + Medicare Certified Home Care… more
    BAYADA Home Health Care (12/18/25)
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