• Utilization Review Nurse

    The County of Los Angeles (Los Angeles, CA)
    UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply  UTILIZATION REVIEW ... information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to...implemented for compliance, as needed. + As a unit supervisor at the LA General Medical Center: + Has… more
    The County of Los Angeles (05/22/25)
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  • Utilization Review Nurse

    The County of Los Angeles (Los Angeles, CA)
    UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply  UTILIZATION REVIEW ... and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
    The County of Los Angeles (03/30/25)
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  • Utilization Review Nurse

    Actalent (Sunrise, FL)
    Utilization Management Nurse !Job Description The ...on department activities as assigned. Essential Skills + Clinical review + Utilization review + ... Working under the general supervision of the Director and/or Manager/ Supervisor of Medical Management, and in collaboration with an...or LPN License. + Minimum of one year of utilization review experience and discharge planning in… more
    Actalent (06/21/25)
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  • Utilization Management Review

    AmeriHealth Caritas (LA)
    …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
    AmeriHealth Caritas (06/25/25)
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  • Utilization Management Review

    AmeriHealth Caritas (Washington, DC)
    …to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... **Role Overview** Under the direction of a supervisor , the Clinical Care Reviewer - Utilization...ability to meet productivity standards in a fast-paced, high-volume utilization review environment The range displayed in… more
    AmeriHealth Caritas (06/03/25)
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  • Utilization Review Registered…

    BJC HealthCare (St. Louis, MO)
    … experience performing care for hospitalized patients. + 2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity ... quality of medical services provided by the medical team. Ensure appropriate utilization , which includes the evaluation of potential under and over- utilization more
    BJC HealthCare (06/24/25)
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  • Pediatric Shift Care Utilization Management…

    AmeriHealth Caritas (Philadelphia, PA)
    **Role Overview** Under the direction of the unit Supervisor , the Clinical Care Reviewer- Shift Care is responsible for managing requests for pediatric shift care ... the case is presented to the Medical Director for medical necessity review . Upon approval of services, responsibilities include timely notification and education to… more
    AmeriHealth Caritas (05/22/25)
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  • Nurse Utilization Management…

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

    Centene Corporation (Jefferson City, MO)
    …flexibility. **_ Remote Role _** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team to ... ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence to… more
    Centene Corporation (06/25/25)
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  • Supervisor , Behavioral Health…

    Centene Corporation (Tallahassee, FL)
    …WILL HAVE BCBA CERTIFICATION **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and ... of BH utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines +… more
    Centene Corporation (06/26/25)
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