• Physician, Radiologist/Mammographer with EDRP…

    Veterans Affairs, Veterans Health Administration (San Antonio, TX)
    …will be responsible for establishing imaging protocols; reviewing imaging requests; utilization management ; ensuring appropriate preps and medication are ... in the FPPE/OPPE process. Adhere to employee health requirements. Participate in peer review process. Time/Leave Management : Adhere to tour of duty. Timely… more
    Veterans Affairs, Veterans Health Administration (10/28/25)
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  • RN Case Manager - Utilization Review

    Prime Healthcare (Lynwood, CA)
    …With Us! (https://careers-primehealthcare.icims.com/jobs/237903/rn-case-manager utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... and service! Responsibilities Responsible for the quality and resource management of all patients that are admitted to the...to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,… more
    Prime Healthcare (12/19/25)
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  • Specialist, Digital Asset Management

    Merck (Juneau, AK)
    …Content Creation, Copyright Compliance, Customer Journey Mapping, Customer Relationship Management (CRM) Utilization , Data Analysis, Design Thinking, ... **Job Description** The US Human Health Global Headquarters (HH GHQ) Asset Management Specialist's scope spans over three primary areas: + Responsible for approving… more
    Merck (01/08/26)
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  • Sr. Manager, Workday Product Management

    Gerber Collision & Glass (Elmhurst, IL)
    …enhancements. + Develop and implement plans for continuous improvement in system utilization and efficiency. People Management : + Manage people, collaborate, and ... and Protected Veterans. Job Description: The Sr. Manager, Workday Product Management - Financials role leads the strategy, configuration, and optimization of… more
    Gerber Collision & Glass (11/12/25)
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  • RN Case Manager

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …health care settings (Inpatient, outpatient, or differing levels of care). * Utilization Management experience, preferred * Active licensure in Massachusetts is ... and regulatory standards to create, follow and appropriately document comprehensive care management plans. * Review medication list and educate members with… more
    Blue Cross Blue Shield of Massachusetts (01/14/26)
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  • Lead Patient Service Rep / Call Center - Santa…

    Cedars-Sinai (Santa Monica, CA)
    …support activities to address physician and staff concerns such as facilities management , patient billing, utilization management , quality management ... front office workflow. This position also assists with providing a review of Patient Service Representative administrative skills, assessing the workflow of… more
    Cedars-Sinai (01/10/26)
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  • Registered Nurse - Community Care Case Manager

    Veterans Affairs, Veterans Health Administration (Columbia, SC)
    …possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Responsibilities… more
    Veterans Affairs, Veterans Health Administration (01/07/26)
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  • Healthcare Analyst Senior

    Blue Cross and Blue Shield of Minnesota (Eagan, MN)
    …This individual pulls and synthesizes data across multiple domains, including utilization management , prior authorization, claims, denials, and appeals. Their ... focus in the department include but are not limited to provider, health management , quality, product development and client/member analytics. A typical day for the… more
    Blue Cross and Blue Shield of Minnesota (01/07/26)
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  • Supervisor Appeals & Grievance Case Res

    AmeriHealth Caritas (Philadelphia, PA)
    …and compliance indicators + **Cross-Functional Collaboration** + Coordinate with Claims, Utilization Management , Member Services, Legal, and Compliance to ensure ... Friday from 8a EST to 5p EST **Responsibilities** + **Leadership and Staff Management ** + Supervise daily activities of assigned Appeals & Grievance staff, including… more
    AmeriHealth Caritas (01/07/26)
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  • Health Insur & Auth Rep III

    University of Rochester (Rochester, NY)
    …Medicare and other payer regulations for the coordination of benefits. + Notifies Utilization Management of clinical requests by third party payers. + Maintains ... considerations._ **Responsibilities:** GENERAL PURPOSE Manages and provides financial account management for all urgent, emergent, and pre-admission visits with a… more
    University of Rochester (01/02/26)
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