• Manager , Utilization…

    Commonwealth Care Alliance (Boston, MA)
    …services, procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and ... managing the daily operation of the Utilization Management Review Nurse and...decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to… more
    Commonwealth Care Alliance (10/02/25)
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  • RN , Manager , Utilization…

    Humana (Augusta, ME)
    **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
    Humana (09/28/25)
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  • Utilization Management…

    State of Indiana (Indianapolis, IN)
    Utilization Management Manager Date Posted: Sep 26, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling ... care and their communities. Role Overview: The role of Utilization Management Manager oversees the...and clinical criteria evaluations.They will possess a current unrestricted RN license from the State of Indiana; a minimum… more
    State of Indiana (09/26/25)
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  • Utilization Management…

    Elevance Health (Washington, DC)
    …office 4 days each week. The office is located at 609 H. Street NE.** The ** Utilization Management ** ** Manager ll** is responsible for managing a team of ... acuity. + Provides direct oversight and is responsible for Utilization Management execution/decision making for managed member...as aligned to license which includes 3 years prior management experience + Current active unrestricted RN … more
    Elevance Health (08/29/25)
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  • Associate Manager , Clinical Health…

    CVS Health (UT)
    …years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals experience in Utilization ... **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development and… more
    CVS Health (10/02/25)
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  • Manager - Utilization Review…

    Beth Israel Lahey Health (Plymouth, MA)
    …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... **Join Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff… more
    Beth Israel Lahey Health (07/29/25)
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  • Utilization Manager…

    Commonwealth Care Alliance (Boston, MA)
    …CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
    Commonwealth Care Alliance (10/02/25)
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  • Case Manager ( RN )…

    Prime Healthcare (Chino, CA)
    …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/226811/case- manager -%28rn%29 utilization - ... an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute… more
    Prime Healthcare (09/30/25)
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  • Utilization Management Rn

    Actalent (Santa Barbara, CA)
    Remote Utilization Management RN Leading...and helpful team + Fully remote!! REQUIREMENTS: + California Registered Nurse ( RN ) and/or ... working as soon as possible! Description: + REMOTE + RN with experience in providing Case Management ...such as Mental/Behavioral Health services. Skills: Care plans, Case Manager , Pediatrics, Utilization Management , Clinical… more
    Actalent (10/01/25)
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  • Senior Manager , Behavioral Health…

    Centene Corporation (Phoenix, AZ)
    …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... care to members. Oversees and works with senior leadership on utilization management issues related to member care, provider interactions, and facilitates… more
    Centene Corporation (09/14/25)
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