• Case Manager RN

    HCA Healthcare (San Antonio, TX)
    …Management will be performed + Prefer at least one year experience in utilization review , resource management, discharge planning or case management. This is ... care. **Your responsibilities will include:** + Assesses by interview and charts review discharge needs of all high-risk patients (and others referred). Identifies… more
    HCA Healthcare (10/05/25)
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  • Medical Director - Medicaid (Oklahoma)

    CVS Health (Madison, WI)
    …a Plus **Preferred Qualifications:** -Preferred Oklahoma residency -Health plan/payor Utilization Management / Review experience. -Managed Care experience. ... that primarily supports the Aetna Better Health Plan of Oklahoma. This UM ( Utilization Management) Medical Director will be a "Work from Home" position primarily… more
    CVS Health (12/19/25)
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  • Quality Management Nurse Consultant

    US Tech Solutions (RI)
    …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF UTILIZATION ... **Job Description:** + Responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets data obtained from… more
    US Tech Solutions (10/17/25)
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  • Care Manager RN *Full Time Day Shift

    Providence (Medford, OR)
    …based on population focus. Duties also include complex discharge planning and utilization review . Providence caregivers are not simply valued - they're ... 1 year Preferred home health, mental health, substance use, hospice, and/or utilization review . + Preferred progressive nursing leadership experience, including… more
    Providence (12/31/25)
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  • Psychiatric Technician - IPU

    Ventura County (Ventura, CA)
    …that establish, expand, and maintain the pool of eligible service providers. + Utilization review : + Uses professional skills in quality management activities ... such as utilization review , monitoring and evaluation procedures, and the development of standards and protocols. + Performs other duties as required… more
    Ventura County (12/31/25)
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  • Health Information Management Technician 1 (NY…

    New York State Civil Service (Binghamton, NY)
    …and clinical staff on health information management requirements.* Conducting audits for utilization review activities and reporting deficiencies to the ... Utilization Review Committee.* Implementing corrective actions as determined by internal and external audit findings.* May supervise lower-level clerical and… more
    New York State Civil Service (12/31/25)
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  • Multi-Site Director Case Management

    Prime Healthcare (Port Huron, MI)
    …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Assesses ... and assessment and evaluation of data/statistics obtained from an on-going review process. 5. Experience and knowledge in basic to intermediate computer… more
    Prime Healthcare (12/31/25)
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  • RN Case Manager

    HCA Healthcare (Ocala, FL)
    …required + 4 year Bachelor Degree preferred. + Certification in Case Management or Utilization Review preferred HCA Florida Ocala Hospital is a 323-bed facility. ... throughput while supporting a balance of optimal care and appropriate resource utilization . + Provides case management services for both inpatient and observation… more
    HCA Healthcare (12/30/25)
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  • Lead Social Worker MSW

    HCA Healthcare (Ocala, FL)
    …of day as assigned by Manager/Director. + First line resource to Case Managers, Utilization Review , and Medical Social Workers. Elevates issues as appropriate. + ... for Case Manages based on appropriate level of care, utilization of services and plan of care. Ensures equitable...for our Lead Social Worker MSW opening. We promptly review all applications. Highly qualified candidates will be contacted… more
    HCA Healthcare (12/30/25)
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  • Case Manager RN

    HCA Healthcare (San Antonio, TX)
    …experienced in Oncology + Prefer at least one year experience in utilization review , resource management, discharge planning or case management. Methodist ... care. **Your responsibilities will include:** + Assesses by interview and charts review discharge needs of all high-risk patients (and others referred). Identifies… more
    HCA Healthcare (12/30/25)
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