• Utilization Management

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... of business. **Knowledge, Skills and Abilities (KSAs)** + Oversight of Utilization Management clinicians while championing process improvement, change adoption… more
    CareFirst (11/22/25)
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  • Utilization Review Nurse Supervisor

    The County of Los Angeles (Los Angeles, CA)
    UTILIZATION REVIEW NURSE SUPERVISOR I Print... Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply  UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 - $167,136.48 Annually Location Los… more
    The County of Los Angeles (12/25/25)
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  • Clinical Supervisor Utilization

    Martin's Point Health Care (Portland, ME)
    …The Supervisor is responsible for day-to-day operations of the utilization review clinical team, in the areas of authorization requests, organizational ... years of medical management experience in a managed care setting including utilization review + RN experience in a clinical setting + Leadership and/or … more
    Martin's Point Health Care (12/23/25)
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  • Clinical Reviewer, Behavioral Health

    Point32Health (MA)
    …Point32Health (https://www.point32health.org/) . **Job Summary** Under the supervision of the Utilization Management Supervisor , the Behavioral Health (BH) ... (UM) Clinician is responsible for conducting benefit coverage reviews and utilization management according to applicable regulatory guidelines and Enterprise… more
    Point32Health (12/23/25)
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  • Utilization Management Reviewer, RN…

    Excellus BlueCross BlueShield (Rochester, NY)
    …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
    Excellus BlueCross BlueShield (10/07/25)
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  • RN Utilization Mgmt I

    Covenant Health Inc. (Knoxville, TN)
    Overview Registered Nurse Utilization Management Full Time, 80 Hours Per Pay Period, Day Shifts Covenant Health Overview: Covenant Health is the region's ... to be named a Forbes "Best Employer" seven times. Position Summary: The RN Utilization Management I will perform utilization management functions… more
    Covenant Health Inc. (12/18/25)
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  • Utilization Management Coordinator…

    Saint Francis Health System (Tulsa, OK)
    …in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal ... Reviews eligibility and benefits of patients, matching the level of care utilization . Assures compliance with Managed Care Behavioral Health standards in the area… more
    Saint Francis Health System (12/31/25)
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  • Utilization Case Manager

    Helio Health Inc. (Syracuse, NY)
    …Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management ... track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our Inpatient,… more
    Helio Health Inc. (12/02/25)
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  • Utilization Review RN

    BayCare Health System (Tampa, FL)
    …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions as the ... necessity of outpatient observation and inpatient stays and the utilization of ancillary services + Perform other duties as...services + Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials.… more
    BayCare Health System (10/10/25)
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  • Manager, Inpatient Pharmacist - Pharmacy…

    University of Rochester (Rochester, NY)
    …conduct the business of the functional unit under their supervision and management . Their supervisor should be aware of all ongoing interdepartmental ... defined by NYS Laws and Regulations. The Pharmacy Medication Utilization and Inventory Compliance Manager has direct supervision and...frequency of reporting will be agreed upon with their Supervisor . + Performs budget management and planning… more
    University of Rochester (11/12/25)
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