• Utilization Review Care…

    Intermountain Health (Las Vegas, NV)
    **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for ... Utilization Management and Review for...Utilization Management and Review for the Enterprise. The...team in delivering and collaborating on all aspects of utilization management and care coordination… more
    Intermountain Health (04/18/25)
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  • AVP, Utilization Review & Pharmacy

    Zurich NA (Carson City, NV)
    …+ Experience in development and implementation of cost containment programs + Case management , utilization review , catastrophic or disability experience + 5 ... AVP, Utilization Review & Pharmacy 123092 Zurich...Care and Claims leadership to create and align utilization and pharmacy cost containment strategies with our customers'… more
    Zurich NA (05/22/25)
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  • Utilization Review Medical Director

    Intermountain Health (Las Vegas, NV)
    …position interacts with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management , care management , claims, network ... management , and finance. As the Medical Director for Utilization Management , you are responsible, in partnership...order to be considered for the position.** Performs medical review activities pertaining to utilization review… more
    Intermountain Health (03/04/25)
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  • Utilization Review Clinician - BH

    Centene Corporation (Carson City, NV)
    …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization...healthcare teams to review care services related to mental health… more
    Centene Corporation (05/25/25)
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  • Utilization Review Specialist

    Reno Behavioral Healthcare Hospital (Reno, NV)
    …as appropriate. + Coordinates an interdisciplinary approach to support continuity of care . + Provides utilization management , transfer coordnation, discharge ... The UR Specialist reviews and monitors patients' utilization of health care services with...reviews on all patients. Monitors level and quality of care . + Responsible for the proactive management … more
    Reno Behavioral Healthcare Hospital (04/27/25)
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  • Physical Therapy Utilization Review…

    Sedgwick (Las Vegas, NV)
    …Work(R) Fortune Best Workplaces in Financial Services & Insurance Physical Therapy Utilization Review Advisor **For client coverage; prefer someone in Mountain ... updated with relevant industry regulations, guidelines, and best practices related to utilization review and maintains compliance with applicable laws and… more
    Sedgwick (04/24/25)
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  • Divisional Director of Care…

    CenterWell (Carson City, NV)
    …program workflows, dyad communication/partnership, and quarterly business review of acute care and post-acute care utilization . + Engage with divisional ... coordinating care to reduce acute and post-acute care utilization . The Divisional Director role is...work with EMR, operational and outcome reporting, knowledge of care management tools and assessments, documentation, and… more
    CenterWell (05/23/25)
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  • Initial Review Pharmacy Technician

    Prime Therapeutics (Carson City, NV)
    …a health plan/health care setting + Experience as Pharmacy Technician, Utilization Management or Customer Service in a high-volume, multi-functional call ... achieving revenue goals and operational objectives. Responsible for executing utilization management programs on behalf of health...exception requests to nurse, pharmacist or physician on the utilization review clinical team when further … more
    Prime Therapeutics (05/29/25)
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  • Medical Director - Care Plus - Florida

    Humana (Carson City, NV)
    …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, ...region or line of business. The Medical Director conducts Utilization Management of the care … more
    Humana (04/24/25)
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  • Care Manager RN - Remote

    Highmark Health (Carson City, NV)
    …This job implements effective ** utilization management ** strategies including: review of appropriateness of health care services, application of criteria ... inquiries and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent… more
    Highmark Health (05/21/25)
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