• UM Care Manager (RN) - PA Candidates…

    UPMC (Pittsburgh, PA)
    …to candidates located in Pennsylvania The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and ... is looking for you! We are hiring a full-time Utilization Management Care Manager to...information obtained from interaction with members and providers. + Review and document clinical information from health care more
    UPMC (09/27/25)
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  • Regional Care Manager

    Wellpath (Franklin, TN)
    …make a difference** The Regional Care Manager (RCM) is responsible for utilization review , care coordination, and daily care management across ... or Care Management Certification + RN preferred EXPERIENCE + Previous utilization review and/or case management and pre-certification experience + Knowledge… more
    Wellpath (09/30/25)
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  • Utilization Review Manager

    Minnesota Visiting Nurse Agency (Minneapolis, MN)
    *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to ... ) required or completed within three years of hire **Title:** * Utilization Review Manager * **Location:** *MN-Minneapolis-Downtown Campus* **Requisition… more
    Minnesota Visiting Nurse Agency (09/30/25)
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  • RN Utilization Manager - (Per Diem)…

    UNC Health Care (Smithfield, NC)
    …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance… more
    UNC Health Care (08/25/25)
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  • Manager - Utilization Review

    Beth Israel Lahey Health (Plymouth, MA)
    …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager...care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely… more
    Beth Israel Lahey Health (07/29/25)
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  • Manager , Utilization Review

    Children's Mercy Kansas City (Kansas City, MO)
    …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
    Children's Mercy Kansas City (09/16/25)
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  • Utilization Review Coordinator

    Behavioral Center of Michigan (Warren, MI)
    …skills to help educate the staff and physicians regarding charting. REPORTS TO: Utilization Review Lead/ Manager QUALIFICATIONS: + High School Diploma or ... Under general supervision, the Utilization Review Coordinator provides professional assessment,...those duties include all tasks requested by the UR Manager , CEO or Medical Director to meet the needs… more
    Behavioral Center of Michigan (09/11/25)
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  • Outcomes Manager , Utilization

    Virtua Health (Pennsauken, NJ)
    …the moments that matter, striving each day to connect you to the care you need. Whether that's wellness and prevention, experienced specialists, life-changing ... care , or something in-between - we are your partner...and AA to support UR and revenue cycle process.Position Responsibilities: Utilization Management* Utilizes Payer specific screening tools as a… more
    Virtua Health (09/26/25)
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  • Utilization Review Nurse - Pool

    Dayton Children's Hospital (Dayton, OH)
    … TeamSchedule:Part timeHours:8Job Details:Under the supervision of the Manager of Utilization Management, the Utilization Review RN conducts medical ... information to payers in accordance with contractual obligations. The Utilization Review RN serves as a resource...as a resource to the physicians, collaborates with the Care Manager in the development and implementation… more
    Dayton Children's Hospital (09/17/25)
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  • Utilization Manager Reviewer, RN…

    Excellus BlueCross BlueShield (Rochester, NY)
    …and departmental policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director. + Utilizes appropriate ... improving member and community health. + Manages more complex assignments; cross-trained to review various levels of care and/or services. + Participate in… more
    Excellus BlueCross BlueShield (08/23/25)
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