• RN Utilization Manager - Rex Case…

    UNC Health Care (Raleigh, NC)
    …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders,… more
    UNC Health Care (06/17/25)
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  • Manager Utilization

    Tufts Medicine (Burlington, MA)
    …with the coordination of the Utilization Management Committee. The Utilization Management Operations Manager follows the system's Utilization ... day support and oversight to Utilization Review departments and UM vendor management . The UM Operations Manager is responsible for compliance with CMS… more
    Tufts Medicine (06/24/25)
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  • Manager , Utilization

    Commonwealth Care Alliance (Boston, MA)
    …services, procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director of… more
    Commonwealth Care Alliance (05/21/25)
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  • Manager Utilization

    Beth Israel Lahey Health (Burlington, MA)
    …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... compliance reviews as needed. + Continuously monitors regulatory requirements for Utilization Management . + Attends Mandatory Education programs required by… more
    Beth Israel Lahey Health (06/06/25)
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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...in utilization management and appeal/denial management . + Holds a strong working knowledge more
    Beth Israel Lahey Health (04/29/25)
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  • Manager , Utilization

    Healthfirst (IA)
    management including preauthorization of outpatient or inpatient services + Knowledge of utilization management /quality management case philosophies ... **Duties/Responsibilities:** + Oversees utilization management functions which include timely...settings for high risk, complex populations + Certified Case Manager + Interqual, Milliman, and/or TruCare knowledge more
    Healthfirst (06/11/25)
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  • RN Case Manager - Utilization

    Trinity Health (Silver Spring, MD)
    **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time ... : Holy Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management , you...the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize… more
    Trinity Health (05/13/25)
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  • Case Manager Utilization Review…

    Beth Israel Lahey Health (Burlington, MA)
    …of three years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ... a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:**...to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and… more
    Beth Israel Lahey Health (05/11/25)
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  • Per Diem RN Case Manager

    Children's Hospital Boston (Boston, MA)
    80451BRJob Posting Title:Per Diem RN Case Manager , Utilization Management /ReviewDepartment:Patient Services-Patient Care ... health needs of the patient and family. + Possessing knowledge of community health services, payer systems and post-acute...a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current… more
    Children's Hospital Boston (06/16/25)
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  • Utilization Case Manager

    Helio Health Inc. (Syracuse, NY)
    …to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our ... Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management more
    Helio Health Inc. (05/30/25)
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