- 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
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …process and initiatives as well as customer service programs. The Utilization Management /Float Registered Nurse ( RN ) is responsible for providing ... Center is looking for recruit for Registered Nurse - Utilization Management /...the Associate Director of Patient Care Services (ADPCS). The Utilization Management /Float ( RN ) follows procedures… more
- Centene Corporation (New York, NY)
- …Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... perspective on workplace flexibility. **Must have an active New York State RN license.** **Inpatient Utilization Management ** **Position Purpose:**… more
- Centene Corporation (Sacramento, CA)
- …Expert knowledge of industry regulations, policies, and standards preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... experience with prior auth is highly preferred** **Position Purpose:** Directs the utilization management team to ensure the appropriate application of policy… more
- Commonwealth Care Alliance (Boston, MA)
- … Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management … more
- UNC Health Care (Morrisville, NC)
- …the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible ... for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a complex academic health system and… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- AmeriHealth Caritas (Lafayette, LA)
- …in a fast-paced, high-volume utilization review environment. **Licensure:** + An active Registered Nurse ( RN ) license in Louisiana or multi state license ... **Role Overview:** Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services,… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Other duties as assigned. Essential Qualifications + Active and unrestricted license as a Registered Nurse ( RN ) + Bachelor's degree in nursing, (or ... About The Role The Manager, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support… more
- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Nov 1, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career ... care and their communities. Role Overview: The role of Utilization Management Manager oversees the integration of...and clinical criteria evaluations.They will possess a current unrestricted RN license from the State of Indiana; a minimum… more
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