• Northern Nevada Medical Center (Sparks, NV)
    …appropriate patient status. Collaborates with physician, physician extender, nurse, case manager/ utilization review and HIM coder to identify principal diagnosis ... utilizes strong communication skills with physician, physician extender, case manager, utilization review , nurse or other healthcare professional, utilizing… more
    Appcast IO CPA (10/13/25)
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  • Cipla (Fall River, MA)
    …Major Activities / Tasks Monitor and control planned production by daily activity review as per p packaging plan to meet packaging targets and quality standards ... Review planned production vs. actual production daily and control...Prepare the facility and rectify issues related to facility management and documentation for audit readiness Handle investigations, OOS,… more
    HireLifeScience (12/18/25)
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  • HCA Healthcare - Chief Medical Officer (Bradenton, FL)
    …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... ongoing in-service programs to facility medical staff regarding clinical resource management , appropriate documents standards, utilization and quality issues,… more
    job goal (12/31/25)
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  • Monogram Health (Fort Myers, FL)
    …populations Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management , and risk adjustment Current state medical ... and the seamless transitions to dialysis, pre-emptive kidney transplant, conservative management . The Regional Medical Executive is a key clinical leader within… more
    job goal (12/27/25)
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  • Clinical Nurse III, Acute Inpatient…

    Alameda Health System (San Leandro, CA)
    Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management + San Leandro, CA + John George Psychiatric Hospital + JGP Care Coordination + ... System) and Behavioral Health Department Alameda County Utilization Review Plan to obtain authorization of...EHR. 17. Maintains current knowledge of clinical practice and Utilization Management by literature review ,… more
    Alameda Health System (12/31/25)
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  • Utilization Management Nurse…

    CVS Health (Phoenix, AZ)
    …partial hospitalization and intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior ... promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this… more
    CVS Health (12/13/25)
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  • Clinical Reviewer , Behavioral

    Point32Health (MA)
    …Point32Health (https://www.point32health.org/) . **Job Summary** Under the supervision of the Utilization Management Supervisor, the Behavioral Health (BH) ... and care management principles. Health Plan experience performing utilization review activities. Experience with McKesson's InterQual Clinical Screening… more
    Point32Health (12/23/25)
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  • Manager Behavioral Health Services

    Elevance Health (Indianapolis, IN)
    …a clinical call center The **Manager Behavioral Health Services** is responsible for Behavioral Health Utilization Management (BH UM), or Behavioral ... cost of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues....and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of… more
    Elevance Health (12/31/25)
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  • RN - Utilization Review

    UnityPoint Health (Cedar Rapids, IA)
    …ID: 174223 Overview This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient ... patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to...State of Iowa Licensed RN + Two years of behavioral health work experience. + Professional communication - written… more
    UnityPoint Health (11/07/25)
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  • Behavioral Health Case Manager (O-5)…

    Immigration and Customs Enforcement (Washington, DC)
    …Perform other duties and responsibilities as assigned. 16. Utilization review / management for inpatient behavioral health hospitalization for IHSC. ... services include and are not limited to the following: case coordination/ management , monitoring high risk individuals, independent behavioral health reviews,… more
    Immigration and Customs Enforcement (12/07/25)
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