• Ops- UM Training Specialist

    Integra Partners (Troy, MI)
    …educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes. The ... a strong nursing background combined with expertise in clinical documentation, medical necessity determination, regulatory compliance, and will be responsible for… more
    Integra Partners (06/03/25)
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  • RN Supervisor UM Prior Auth

    Dignity Health (Rancho Cordova, CA)
    …the Supervisor of Utilization Management is responsible and accountable for coordination of services for Mercy Medical Group and Woodland Clinic Medical ... of care. Promotes the quality and cost effectiveness of medical care by ensuring department staff are applying clinical...is responsible for coordinating the daily operations of the UM Pre-Authorization team in order to ensure requests are… more
    Dignity Health (06/20/25)
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  • Care Manager ( UM /UR) - Remote,…

    Magellan Health Services (Boise, ID)
    …community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria. + Participates in ... solutions that directly influence quality of care. General Job Information Title Care Manager ( UM /UR) - Remote, Idaho Licensed Grade 24 Work Experience -… more
    Magellan Health Services (07/26/25)
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  • UM Administration Coordinator 2

    CenterWell (Tallahassee, FL)
    …of senior-focused primary care, one of the largest providers of home health services , and fourth largest pharmacy benefit manager , CenterWell is focused on ... a part of our caring community and help us put health first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM more
    CenterWell (07/26/25)
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  • Pharmacist, Utilization Management ( UM )

    Molina Healthcare (Vancouver, WA)
    **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services /Management staff work to ensure that Molina members have access to all medically necessary prescription ... drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review, patient… more
    Molina Healthcare (07/27/25)
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  • Manager , UM Behavioral Health

    Humana (Oklahoma City, OK)
    …support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Manager , Utilization ... part of our caring community and help us put health first** The Manager , Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to… more
    Humana (06/26/25)
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  • Manager Behavioral Health Services

    Elevance Health (Wallingford, CT)
    …for Behavioral Health Utilization Management (BH UM ) only The ** Manager Behavioral Health Services ** is responsible for Behavioral Health Utilization ... Management (BH UM ), or Behavioral Health Case Management (BH CM) or...make an impact:** + Serves as a resource for medical management programs. Identifies and recommends revisions to policies/procedures.… more
    Elevance Health (07/25/25)
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  • Manager - Case Management & Social…

    Houston Methodist (Sugar Land, TX)
    …and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and exceed service -level goals ... At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible...quality improvement processes related to admission, concurrent and retrospective UM and medical claims programs. Collaborates with… more
    Houston Methodist (07/24/25)
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  • Compliance and Outcomes Manager

    Horizon Services, Inc. (Albuquerque, NM)
    …and $500 after 12 months of employment) JOB TITLE: Compliance and Outcomes Manager LOCATION: Gateway Medical Sobering- Albuquerque, New Mexico Who are we? ... Horizon Services , Inc. (HSI) is a nonprofit established in 1974...with billing entries in electronic systems, and other program UM , census, revenue, or service -related data. Data… more
    Horizon Services, Inc. (06/29/25)
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  • RN Manager , Case Management

    Providence (Santa Rosa, CA)
    …Accredited Case Manager (ACM) upon hire + For Case Management/ UM Review: Strong operations experience. **Why Join Providence?** Our best-in-class benefits are ... of the RN Case Managers in the Care Management Department. The Manager role models proactive, collaborative working relationships across all functions. Specifically… more
    Providence (06/26/25)
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