• Care Review Clinician, PA (RN)

    Molina Healthcare (Ann Arbor, MI)
    …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
    Molina Healthcare (09/05/25)
    - Related Jobs

  • Enhanced Care Management Clinical…

    LA Care Health Plan (Los Angeles, CA)
    …in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The expected pay range ... the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and… more
    LA Care Health Plan (07/16/25)
    - Related Jobs

  • Technical Audit Manager

    Safran (Gainesville, TX)
    …accordance with the defining processes. The role does not involve the direct management of other employees, primarily it involves the effective independent review ... necessary, must be ready to explain those findings to management as part of the process to agree to...of new product/feature development). B) Act as an independent reviewer of both Master Engineering Reviews and Part Design… more
    Safran (10/04/25)
    - Related Jobs

  • Management Analyst II

    Fairfax County Sheriff's Office (Fairfax, VA)
    …plans when needed. + Evaluate Service Quality: Work in collaboration with the Utilization Review (UR) team to assess facilities and services against current ... + Behavioral Health Expertise: A solid understanding of children's behavioral healthcare, case management , and evidence-based practices. + Critical Thinking… more
    Fairfax County Sheriff's Office (10/12/25)
    - Related Jobs

  • Assistant Chief, Clinical Social Work

    The County of Los Angeles (Los Angeles, CA)
    …the performance of subordinate supervisory staff and serves as first level reviewer of all performance evaluations. + Resolves or consults with subordinate ... supervisors to resolve problems of employee utilization , employee discipline, and grievances. + Develops in-service training activities to increase professional… more
    The County of Los Angeles (09/03/25)
    - Related Jobs

  • Manager I Care Management…

    Elevance Health (Sylva, NC)
    …and overseeing assigned care managers and ensuring fidelity to the CFSP Care Management model which includes physical health, behavioral health, and social ... the same basic benefits and services, including Physical health, Behavioral health, Pharmacy,_ _Intellectual/Developmental_ _Disabilities (I/DD) services, long term… more
    Elevance Health (10/11/25)
    - Related Jobs

  • Discharge Planner

    Prime Healthcare (Boonton Township, NJ)
    …Plan. Qualifications Education and Work Experience + Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and functions, ... of hospitals and healthcare facilities include Denville Hospital, Dover Hospital, Behavioral Health Centers in Boonton, Denville, and Parsippany, and an Imaging… more
    Prime Healthcare (09/26/25)
    - Related Jobs

  • Community Health Worker

    Commonwealth Care Alliance (Springfield, MA)
    …medical, behavioral , and social complexities that require intensive care management and care delivery. Within the CIC Program, the Community Health Worker ... programing is responsible for providing care delivery and care management to a specific panel of high risk and...and care coordination for the most complex medical and behavioral health patients. The CHW participates in aiding the… more
    Commonwealth Care Alliance (10/08/25)
    - Related Jobs

  • Senior Medical Director, Aetna Better Health…

    CVS Health (Springfield, IL)
    …expertise and oversight to all areas within the clinical services including Care Management , Utilization Management , Population Health, Health Equity and ... Service Officer, and other executive team members in managing all Behavioral Health activities by driving clinical excellence, achieving measurable health outcomes,… more
    CVS Health (09/10/25)
    - Related Jobs

  • Manager of Case Management

    HCA Healthcare (Brandon, FL)
    …and personal growth, we encourage you to apply for our Manager of Case Management opening. We promptly review all applications. Highly qualified candidates will ... have the career opportunities as a(an) Manager of Case Management you want with your current employer? We have...for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services… more
    HCA Healthcare (09/09/25)
    - Related Jobs