• Supervisor , Utilization

    LA Care Health Plan (Los Angeles, CA)
    Supervisor , Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM)...in Nursing Experience Required: Minimum of 7 years of acute/ clinical care experience. Minimum of 2 years of experience… more
    LA Care Health Plan (10/14/25)
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  • Utilization Management Reviewer

    AmeriHealth Caritas (Washington, DC)
    …ON BONUS** **Role Overview:** Under the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
    AmeriHealth Caritas (09/01/25)
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  • Supervisor , Utilization

    Centene Corporation (New York, NY)
    …**Must have an active New York State RN license.** **Inpatient Utilization Management ** **Position Purpose:** Supervises Prior Authorization, Concurrent Review, ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks… more
    Centene Corporation (11/09/25)
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  • Utilization Management Reviewer, RN…

    Excellus BlueCross BlueShield (Rochester, NY)
    …in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to ... staff, members and providers. + Provides backup for the Supervisor , whenever necessary. Participates in the orientation of new...Bachelors degree preferred. + Minimum of three years of clinical experience required. Utilization Management more
    Excellus BlueCross BlueShield (10/07/25)
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  • Utilization Management Reviewer

    AmeriHealth Caritas (Lafayette, LA)
    **Role Overview:** Under the direction of a supervisor , the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient ... based on clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of services, identifies… more
    AmeriHealth Caritas (11/04/25)
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  • Registered Nurse (RN) Utilization

    Commonwealth Care Alliance (Boston, MA)
    013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
    Commonwealth Care Alliance (10/02/25)
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  • Senior Registered Nurse - Hospital…

    Ventura County (Ventura, CA)
    …as needed for outside services for patients/families; + Conducts daily clinical reviews for utilization /quality management activities based ... Senior Registered Nurse - Hospital Management Utilization Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5061650) Apply ...+ Preceptor Pay - $2.50 per hour + House Supervisor Pay - $4.00 per hour + Charge Nurse… more
    Ventura County (09/21/25)
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  • Utilization Management Nurse (RN)…

    Saint Francis Health System (OK)
    …placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the ... and on weekend days.** Job Summary: Provides administrative and clinical support to the hospital and treatment teams throughout...nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location:… more
    Saint Francis Health System (11/12/25)
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  • Utilization Management Coordinator

    Saint Francis Health System (Tulsa, OK)
    …not all inclusive nor does it prohibit the assignment of additional duties. Utilization Management - Laureate Campus Location: Tulsa, Oklahoma 74136 **EOE ... through Friday, 8:00 am to 5:00 pm** Job Summary: Provides administrative and clinical support to the hospital and treatment team throughout the review of patients,… more
    Saint Francis Health System (11/14/25)
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  • Utilization Management Assistant

    Providence (Anaheim, CA)
    **Description** Under the direction of the Utilization Supervisor / Manager, this position is responsible for the distribution, review, accurate and timely ... (CMA) upon hire. + 1 year - Experience in utilization management or case management ...the California Fair Chance Act." **About the Team** Providence Clinical Network (PCN) is a service line within Providence… more
    Providence (11/11/25)
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