• 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 ... managing the daily operation of the Utilization Management Review Nurse and...decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to… more
    Commonwealth Care Alliance (05/21/25)
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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 ... + Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current Massachusetts license as a… more
    Children's Hospital Boston (06/16/25)
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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 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...+ Current MA RN Licensure required; Bachelor's degree in nursing , health care administration or related field preferred or… more
    Beth Israel Lahey Health (04/29/25)
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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

    Healthfirst (IA)
    **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… more
    Healthfirst (06/11/25)
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  • Registered Nurse Case Manager

    Prime Healthcare (Weslaco, TX)
    …Full Time Shift Days Connect With Us! (https://careers-primehealthcare.icims.com/jobs/210205/registered- nurse -case- manager utilization - management ... in a related field. At least one year experience in case management , discharge planning or nursing management ;2. CCM or obtained within 6 months of hire.3.… more
    Prime Healthcare (06/06/25)
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  • Nurse Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    …CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
    Commonwealth Care Alliance (05/23/25)
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  • Case Manager (RN) - Utilization

    Prime Healthcare (Montclair, CA)
    …Shift Days Connect With Us! (https://careers-primehealthcare.icims.com/jobs/208989/case- manager -%28rn%29 utilization - management ... years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse ...experience preferred. At least one year experience in case management , discharge planning or nursing management more
    Prime Healthcare (05/28/25)
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  • System Utilization Management SUM…

    Alameda Health System (Oakland, CA)
    …requirements. 16. Participate in orientation of fresh staff as requested by the Manager of Utilization Management . 17. Maintains knowledge of current ... System Utilization Management SUM Utilization Review...Services As Needed / Per Diem - Varies + Nursing + $61.76 - $102.90 + Req #:41846-31001 + FTE:0.01… more
    Alameda Health System (05/06/25)
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