• UM Supervisor (RN)

    Amergis (Rancho Cordova, CA)
    …charge/lead/supervisory/ management experiencerequired Amergis Healthcare Staffing is seeking a Supervisor Utilization Management Prior Authorization ... Salary: $1760 / Week Supervisor Utilization Management PriorAuthorization Anticipated Duration: ASAP - 3 monthcontract Location Address: Rancho Cordova CA… more
    Amergis (06/06/25)
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  • Supervisor , Utilization

    Centene Corporation (Jefferson City, MO)
    …key initiatives and to facilitate on-going communication between utilization management team, members, and providers + Monitors prior authorization, ... Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure… more
    Centene Corporation (06/25/25)
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  • Supervisor , Behavioral Health…

    Centene Corporation (Tallahassee, FL)
    …licensure as outlined by the applicable state required. Knowledge of BH utilization management principles preferred. Prior supervisory experience preferred ... to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization more
    Centene Corporation (06/26/25)
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  • Supervisor Utilization

    Excellus BlueCross BlueShield (Buffalo, NY)
    …coordinates and is accountable for the daily work of employees who provide utilization management , clinical and medical necessity claim related services and ... PT, NP, PA, or Dietician) with a minimum of three years of utilization management /quality improvement experience or equivalent required. + Must possess a… more
    Excellus BlueCross BlueShield (06/05/25)
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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 (06/25/25)
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  • Supervisor , Utilization Review…

    Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
    …Healthcare providers, subscribers, claims, appeals, legal, networking, case management , customer service, and compliance. **QUALIFICATIONS** **Education** + ... managed care experience or three years BCBSLA + Care Management experience with progressive levels of responsibility and expertise...drug screening after an offer has been extended and prior to hire for all positions. As part of… more
    Blue Cross and Blue Shield of Louisiana (06/20/25)
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  • Nurse Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA… more
    Commonwealth Care Alliance (05/23/25)
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  • Utilization Management Review Nurse

    AmeriHealth Caritas (LA)
    …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...home healthcare or a medical office setting. + Previous prior authorization experience is required.; + Proficiency in Electronic… more
    AmeriHealth Caritas (06/25/25)
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  • Utilization Review Nurse

    Actalent (Sunrise, FL)
    Utilization Management Nurse!Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ... Working under the general supervision of the Director and/or Manager/ Supervisor of Medical Management , and in collaboration...activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management more
    Actalent (06/21/25)
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  • Utilization Management Services Rep…

    Excellus BlueCross BlueShield (Rochester, NY)
    …encourage you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and ... attendance is expected and required. + Performs other functions as assigned by management . Level II (in addition to Level I Accountabilities) + Assists and performs… more
    Excellus BlueCross BlueShield (05/29/25)
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