- Centene Corporation (Richmond, VA)
- …workflows, enhancing data accuracy, and driving efficiency to support timely and compliant claims outcomes. + Leads utilization management team on ... + Partner closely with claims and clinical and non-clinical Utilization Management (UM) team members to align processes and improve end-to-end handling of… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... Generous paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing… more
- TEKsystems (Martinez, CA)
- …efficiency. Job Description: Contra Costa Health is offering an excellent opportunity for a Claims Director . The Claims Director plays a leadership ... regulatory compliance, and the financial integrity of the health plan. The Claims Director works closely with executive leadership and cross-functional partners… more
- Humana (Raleigh, NC)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- AIG (New York, NY)
- …are reimagining the way we help customers to manage risk. Join us as a Complex Claims Director to play your part in that transformation. It's an opportunity to ... assess liability and damages, recommend reserves, present large value cases to senior claims management , and attend mediations and trials. You will need… more
- Humana (Juneau, AK)
- …reports to Lead depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Houston Methodist (Katy, TX)
- …to ensure operational effectiveness and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet ... other areas according to department specifications. + Manages utilization management (UM) programs including Medical Claims Review, Precertification and… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Guthrie (Cortland, NY)
- …for those with less than one year of experience) Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic ... Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of...requirements and to assist in ensuring generation of clean claims in a timely manner + Securing authorization as… more
- South Middlesex Opportunity Council (Framingham, MA)
- …casual Working Conditions: As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact with ... children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. Candidates must… more
Recent Jobs
-
Instructor- General Chemistry Laboratory (Part-Time, Fall 2025 or Spring 2026)
- Suffolk University (Boston, MA)
-
Summer Intern, Cloud Engineer (AWS / Azure) (MD/VA)
- ICF (Reston, VA)
-
Construction Design Engineer
- Tutor Perini (Milwaukee, WI)
-
Sr. Staff Software Engineer, AI Automation (Developer Productivity)
- LinkedIn (Mountain View, CA)