• 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 NURSE ... information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our...implemented for compliance, as needed. + As a unit supervisor at the LA General Medical Center: + Has… more
    The County of Los Angeles (10/06/25)
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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 NURSE ... administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the… more
    The County of Los Angeles (09/27/25)
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  • Utilization Review Assistant

    St. Luke's University Health Network (Allentown, PA)
    …improvement activities. + Provide support to Network Director Utilization Review , Utilization Review Nurses and the Supervisor to Utilization ... serve, regardless of a patient's ability to pay for health care. The Utilization Review Assistant is responsible for taking the data provided to their department… more
    St. Luke's University Health Network (11/06/25)
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  • Supervisor , Utilization Management

    Centene Corporation (New York, NY)
    Utilization Management** **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 (11/09/25)
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  • Utilization Review RN

    BayCare Health System (Tampa, FL)
    …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... services + Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials....Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
    BayCare Health System (10/10/25)
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  • Utilization Management Reviewer, RN…

    Excellus BlueCross BlueShield (Rochester, NY)
    …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
    Excellus BlueCross BlueShield (10/07/25)
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  • Utilization Management Reviewer

    AmeriHealth Caritas (Lafayette, LA)
    …a managed care organization. + Proficiency in Electronic Medical Record Systems and Utilization Review Systems (eg, JIVA) to efficiently document and assess ... **Role Overview:** Under the direction of a supervisor , the Utilization Management Reviewer evaluates...patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
    AmeriHealth Caritas (11/04/25)
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  • Senior Registered Nurse - Hospital Management…

    Ventura County (Ventura, CA)
    …the general and specialized principles, practices, techniques and methods of utilization review /management, discharge planning or case management. + utilize ... Senior Registered Nurse - Hospital Management Utilization Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5061650) Apply  Senior Registered Nurse… more
    Ventura County (09/21/25)
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  • Utilization Case Manager- Inpatient Program

    Helio Health Inc. (Syracuse, NY)
    …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
    Helio Health Inc. (10/30/25)
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  • Utilization Manager Registered Nurse (RN)…

    Commonwealth Care Alliance (Boston, MA)
    …service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
    Commonwealth Care Alliance (10/02/25)
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