• Chief Medical Officer

    WMCHealth (Valhalla, NY)
    …of quality and cost improvement that is data driven and develops systems to review utilization of resources and measure outcomes of care. Monitors physician data ... in association with the DIO of NYMC + Reviews utilization of hospital clinical resources and provides guidance when...interpretation of trends to physicians and hospital committees for review . + Assures that quality management programs are carried… more
    WMCHealth (11/04/25)
    - Related Jobs

  • UM Administration Coordinator

    Humana (St. Paul, MN)
    …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
    Humana (01/01/26)
    - Related Jobs

  • Case Manager Care Continuity Services RN - Care…

    Truman Medical Centers (Kansas City, MO)
    …both spoken and written **Preferred Qualifications:** + RN experience in hospital utilization review , utilization management, or case management **Why ... Join Us?** + Make a real difference by advocating for patients and improving their care journey + Collaborate with a supportive, mission-driven team + Grow your expertise in case management and care coordination **Working at University Health is about making a… more
    Truman Medical Centers (01/01/26)
    - Related Jobs

  • 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. ... years) discharge planning, case management and home care required. Knowledge of Utilization Management. Use of computer applications related to health care industry… more
    Kaleida Health (12/31/25)
    - Related Jobs

  • Clinical Pharmacy Specialist - Pain Management

    Veterans Affairs, Veterans Health Administration (Harlingen, TX)
    …clinical pharmacy practice or specialty area of pharmacy such as quality assurance/ utilization review , informatics systems, drug information, etc. This level of ... patients. Serves as an authoritative information source on drugs and their utilization in therapy. Evaluates the drug literature by analysis of experimental design… more
    Veterans Affairs, Veterans Health Administration (12/31/25)
    - Related Jobs

  • Case Manager RN

    HCA Healthcare (San Antonio, TX)
    …Case Management will be performed. + Prefer at least one year experience in utilization review , resource management, discharge planning or case management. + RN ... functional and self-care abilities; 2) facilitate system access and appropriate utilization of services; 3) facilitate communication and coordination of efforts… more
    HCA Healthcare (12/31/25)
    - Related Jobs

  • SLH Care Management Specialist

    Alameda Health System (San Leandro, CA)
    …specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post ... Required Experience: Three years in a health care field or one year in Utilization Management at a Medical Group or Health plan experience; electronic Health Record… more
    Alameda Health System (12/31/25)
    - Related Jobs

  • Nurse Case Manager

    Battelle Memorial Institute (Fort Campbell, KY)
    …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... will support positive programs for equal treatment of all staff and full utilization of all qualified employees at all levels within Battelle._ The above statements… more
    Battelle Memorial Institute (12/30/25)
    - Related Jobs

  • Pharmacist - Part Time - Days - 8hr FPH

    Emanate Health (Glendora, CA)
    …for performing clinical consults according to pharmacy guidelines and conducting ongoing drug utilization review to promote effective, safe and efficient use of ... medications. Supervises technicians to optimize workflow and resource utilization . Actively participates in CQI activities. **Job Requirements** **Minimum Education… more
    Emanate Health (12/30/25)
    - Related Jobs

  • RN Case Manager

    University of Utah Health (Salt Lake City, UT)
    …+ Negotiates with third party payers relative to benefit levels, eligibility, utilization review , and reimbursement. + Identifies actual and potential delays ... in service requests or treatment and communicates them to health care team so steps can be taken to eliminate or minimize delays. + Works with other team members to plan appropriate and timely discharges. + Establishes measurable discharge planning and… more
    University of Utah Health (12/29/25)
    - Related Jobs