• Director , Utilization…

    Fallon Health (Worcester, MA)
    …and clinical functions related to outpatient and inpatient, utilization management operations, including but not limited to prior authorization, concurrent ... + Recommends and implements innovative process improvements for the prior authorization and utilization management ...cost of care opportunities related to Utilization Management . + Works with VP/ Medical Director … more
    Fallon Health (12/14/25)
    - Related Jobs

  • Medical Director - Medical Affairs…

    CVS Health (Springfield, IL)
    …in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities ( prior authorization and appeals) and responds ... 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
    CVS Health (10/23/25)
    - Related Jobs

  • Director of Case Management…

    Prime Healthcare (Inglewood, CA)
    …Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients ... ie full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management… more
    Prime Healthcare (10/18/25)
    - Related Jobs

  • Senior Utilization Review Medical…

    Integra Partners (Troy, MI)
    …funded programs; no OIG sanctions + 5+ years of utilization management experience, including complex case review + Prior leadership experience overseeing ... (Senior MD) serves as the clinical and strategic leader for Integra's Utilization Management (UM) and Credentialing programs. This is a full-time, 40+… more
    Integra Partners (12/03/25)
    - Related Jobs

  • Utilization Review Medical Director

    Integra Partners (Troy, MI)
    …of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, salaried role functions ... The Utilization Review Medical Director is responsible...or past OIG or state sanctions + Experience performing utilization management or clinical review activities +… more
    Integra Partners (12/02/25)
    - Related Jobs

  • Director Utilization…

    Healthfirst (NY)
    …leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requests** + **Develop strong ... maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** +… more
    Healthfirst (12/04/25)
    - Related Jobs

  • Utilization Management Reviewer, RN…

    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
    Excellus BlueCross BlueShield (10/07/25)
    - Related Jobs

  • System VP Utilization Management

    CommonSpirit Health (Phoenix, AZ)
    **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials … more
    CommonSpirit Health (11/02/25)
    - Related Jobs

  • Manager, Organ Utilization

    LifeCenter Northwest (Bellevue, WA)
    …or operational needs. + Collaborate with the Director , Organ Utilization , to manage departmental budgets and identify cost- management opportunities without ... clinical proficiency and participate in on-call schedule as directed by the Director , Organ Utilization , available for consultation outside of regular working… more
    LifeCenter Northwest (12/10/25)
    - Related Jobs

  • LPN- Utilization Mgmt Reviewer - Case…

    Guthrie (Cortland, NY)
    …Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for ... Summary The LPN Utilization Management (UM) Reviewer, in collaboration...Coordination and other hospital departments as appropriate to obtain prior authorization required to meet contractual reimbursement requirements and… more
    Guthrie (10/28/25)
    - Related Jobs