- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Cottingham & Butler/ SISCO** 1 Positions ID: 4627707008 Posted On 07/01/2025 Refreshed On 11/23/2025 **Job Overview** ** Utilization ... requests such as hospital stays, outpatient surgeries, outpatient tests, care, etc. Review requests and match up to an evidence-based guideline to ensure proper… more
- Samaritan Daytop Village (Rhinebeck, NY)
- …staff as needed with assuring compliance with external and internal utilization review /quality and appropriateness requirements. What qualifications do you ... mission and goal of sustaining high quality care/service delivery to persons served, the Utilization Manager works to assist CASAC Counselors and supervisory… more
- Healthfirst (NY)
- …maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** + ... Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions** + **Partner with technology and data teams to refine data… more
- CenterWell (San Juan, PR)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CenterWell (Austin, TX)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and Blue Shield of Minnesota Position Title: Senior Business Analyst - Utilization Management Location: Hybrid | Eagan, Minnesota Career Area: Information Technology ... business solutions through research, audit, and analysis of data for Utilization Management. Your Responsibilities * Participates in process change and redesign… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical information ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing stay.… more
- Northeast Alabama Regional Medical Center (Anniston, AL)
- …years of clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred. Extensive knowledge and understanding of ... stay reviews to assure hospitalizations meet payor requirements. Maintains records of review information and outcomes for billing purposes and for compliance with… more
- CentraCare (St. Cloud, MN)
- …Full time Responsible for providing administrative support to Care Management and Utilization Review departments. Functions as a communication link for the ... team and assists with coordinating discharge activity for hospitalized patients. Coordinates the payor contact process to assure required and requested information is provided. Utilizes a variety of professional skills such as computer/word processing and… more
- Integra Partners (Troy, MI)
- …Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES + Monitor ... incoming faxes + Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes + Verify eligibility and claim history in proprietary claims… more