• Clinical Physician 2

    New York State Civil Service (West Haverstraw, NY)
    …care and high-quality clinical outcomes. Participation in quality improvement, utilization review , and clinical documentation integrity initiatives. Willingness ... to mentor mid-level providers, residents, or students. Familiar with electronic health record (EHR) systems. Engagement in evidence-based practice and performance improvement projects. Interest in program development and rehabilitation outcome research.… more
    New York State Civil Service (12/13/25)
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  • General Liability Adjuster

    Sedgwick (Miami, FL)
    …and physician filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. **ADDITIONAL ... FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. NY… more
    Sedgwick (12/12/25)
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  • Clinical Physician 2 (NY Helps)

    New York State Civil Service (West Haverstraw, NY)
    …care and high-quality clinical outcomes. Participation in quality improvement, utilization review , and clinical documentation integrity initiatives. Willingness ... to mentor mid-level provider, resident, or students. Familiar with electronic health record (EHR) systems. Engagement in evidence-based practice and performance improvement projects. Interest in program development and rehabilitation outcome research.… more
    New York State Civil Service (12/12/25)
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  • Claims Representative - Liability

    Sedgwick (Milwaukee, WI)
    …and physician filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. **ADDITIONAL ... FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATION** **Education & Licensing** Bachelor's degree from an accredited college or university preferred.… more
    Sedgwick (12/11/25)
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  • Clinical Director

    BriteLife Recovery (Hilton Head Island, SC)
    …Director, and BHT Supervisor to deliver excellent client care. + Works with Utilization Review Department to address billing needs. Responds to inquires from ... billing promptly. + Participates in the recruitment and interview process for clinical staff. + Completes performance appraisals for clinical staff on an annual basis and works with Human Resources on employee performance management throughout the year. +… more
    BriteLife Recovery (12/11/25)
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  • Resident Care Coordinator Assistant (Rcca)

    Athena Health Care Systems (Middletown, CT)
    …of MDS. + Retrieves/Prints and faxes medical records to managed care companies for utilization review purposes. + Transmits MDSs to the State database. + Prints ... and files MDS, CAAs and care plans. + Retrieves QM reports and emails to facility and Athena staff. + Reproduces care plans that have been edited by interdisciplinary team members. + Tracks and schedules all Medicare certifications and recertification. + Mails… more
    Athena Health Care Systems (12/11/25)
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  • RN Case Manager

    Cleveland Clinic (Warrensville Heights, OH)
    …of eligibility (CTM, ACM, CCM or AHA) + Two years of recent experience in utilization review , quality or care management + Knowledge of acute care and ... accreditation requirements + Experience in discharge planning and quality improvement + Adult in-patient hospital or Med/Surg experience **Physical Requirements:** + Requires full range of motion, manual and finger dexterity and eye-hand coordination. +… more
    Cleveland Clinic (12/10/25)
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  • Nurse Case Manager

    Nuvance Health (Carmel, NY)
    …years RN experience in an acute care setting; Leadership experience preferred; Utilization review , discharge planning or case management experience preferred. ... Location: Carmel-PHC 670 Stoneleigh Avenue Work Type: Full-Time Standard Hours: 37.50 FTE: 1.000000 Work Schedule: Day 10 Work Shift: This is a Monday thru Friday position with rotating weekends. 8am-4pm Org Unit: 1168 Department: Care Coordination Exempt: Yes… more
    Nuvance Health (12/10/25)
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  • Special Operations Case Manager (75th RR, Ft.…

    KBR (Fort Benning, GA)
    …compliance in meeting care goals. + Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... risk management issues in order to improve practice, and ensure compliance. + Knowledge and skills in the use of VA/DOD Clinical Practice Guidelines in order to ensure an evidence based standardized process of care to military beneficiaries. + *Knowledge of… more
    KBR (12/10/25)
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  • Hospice Clinical Coordinator

    Elara Caring (Topeka, KS)
    …+ Assists staff in maintaining current and accurate medical records and utilization review . + Assists clinical supervisor with non-clinical phone inquiries. ... + Notifies supervisor of any problems requiring administrative attention and intervention. + Processes and distributes in and out daily mail for the department, collects and maintains inventory, and cleans equipment. + Implements all available actions to… more
    Elara Caring (12/09/25)
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