• Commonwealth Care Alliance (Boston, MA)
    …Knowledge, Skills & Abilities (must have): - Expertise in managing utilization review processes including prior authorization, concurrent and retrospective ... is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting… more
    DirectEmployers Association (10/02/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
    DirectEmployers Association (10/02/25)
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  • BroadPath Healthcare Solutions (Tucson, AZ)
    …+ Minimum 3 years of experience in Managed Care, Provider Office, or Utilization Review organization required. + Knowledge of Commercial, Medicare, and Medi-Cal ... determinations. + Prepare and present authorization requests with supporting documentation for review with the Medical Director. + Assume responsibility for… more
    DirectEmployers Association (09/13/25)
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  • Endeavor Health (Skokie, IL)
    …Degree Health Administration Required Or Bachelors Degree Nursing Required 3 Years Utilization review , discharge planning, case management or disease management ... is responsible for the case management, care coordination management, and utilization management of his/her population of patients across multiple care levels… more
    Talent (10/25/25)
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  • Alameda Health System (San Leandro, CA)
    …Within the last 3 years, experience in Case Management in an acute setting or utilization review at a medical group or health plan. Required ... necessarily performed by each individual in the classification. + Coordinates all utilization review functions, including response to payor requests for… more
    DirectEmployers Association (10/15/25)
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  • GCG (Chicago, IL)
    …adoption + Drive change management and user training to ensure effective system utilization across the organization + Monitor system performance and user feedback to ... management process (3+ years) + Experience leading and facilitating 9-box talent review and succession planning (3+ years) + Hands-on experience implementing or… more
    DirectEmployers Association (10/16/25)
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  • The George Washington University Hospital (Washington, DC)
    …Compensation Career development opportunities across UHS and our 300+ locations! Excellent Medical , Dental, Vision, and Prescription Drug Plan Generous Paid Time Off ... shift oversight for clinical practice, staffing, patient flow, safety, service, and utilization of resources for daily operations. Maintains the environment of care.… more
    Appcast IO CPA (09/22/25)
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  • Stanford Health Care (Palo Alto, CA)
    …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... toward that end, to avoid duplication and misuse of medical services, control costs by reducing inefficient services, and...team members; arranges follow up care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and… more
    DirectEmployers Association (08/21/25)
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  • Fresenius Medical Care (Cadiz, KY)
    About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As ... a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in...activities. Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. Manages… more
    Talent (10/25/25)
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  • Fresenius Medical Care (Waukegan, IL)
    …communicated to and implemented by the facility staff. Maintains integrity of medical records and other FMS administrative and operational records. Complies with all ... systems as pertinent. STAFF: Responsible for implementation of FMS staffing, and medical supply models, to provide quality patient care, and makes recommendations.… more
    Talent (10/25/25)
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