• Utilization Management

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... Preferred **Experience:** 5 years Clinical nursing experience. 2 years Care Management and/or Utilization Management . **Preferred Qualifications:** + … more
    CareFirst (10/22/25)
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  • ABA Utilization Review (UR)…

    Spectrum Billing Solutions (Skokie, IL)
    …mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist | Revenue ... in a cohesive and rewarding environment. This is a remote or office/home hybrid position. Your Responsibilities: + Review... Utilization Review Specialist | ABA Utilization Management Specialist | ABA… more
    Spectrum Billing Solutions (09/01/25)
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  • Specialist (Part-time) - Utilization

    Penn State Health (Hershey, PA)
    …that prohibit or outlaw discrimination._ **Union:** SEIU Healthcare Pennsylvania **Position** Specialist (Part-time) - Utilization Management **Location** ... for maintaining compliance with the CMS Conditions of Participation for Utilization Management . **MINIMUM QUALIFICATION(S):** + Bachelors Degree in Nursing… more
    Penn State Health (10/21/25)
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  • Utilization Management

    TEKsystems (Los Angeles, CA)
    …3 days remote and 2 on-site (Tues/Thurs). M-F 8am - 5pm.Position Overview The Utilization Management Specialist plays a critical role within the Quality ... Management department, serving as the last line of defense for claims that have been denied. This position is responsible for researching denied claims, gathering necessary information, and facilitating resubmission to Health Plans. The ideal candidate will… more
    TEKsystems (10/18/25)
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  • Temporary Behavioral Health Utilization

    CDPHP (Latham, NY)
    …these values and invites you to be a part of that experience. The BH Utilization Specialist is responsible for coordination of care for CDPHP members across the ... an acute or subacute level of care. The BH Utilization Specialist will conduct telephonic care coordination...a hospital setting required. + Minimum one (1) year quality/ utilization management experience in health care setting… more
    CDPHP (10/16/25)
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  • Denials Management Specialist (RN…

    St. Luke's University Health Network (Allentown, PA)
    …serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical ... billing with information needed to obtain payment of claims. Remote within local geography after orientation. JOB DUTIES AND...+ Prefer minimum of 2-5 years' experience in case management and/or utilization management . +… more
    St. Luke's University Health Network (08/13/25)
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  • Sr Specialist , Field Inventory (US…

    Terumo Neuro (Aliso Viejo, CA)
    **12993BR** **Title:** Sr Specialist , Field Inventory (US Remote ) **Job Description:** Oversee and optimize field-based inventory across trunk stock, ... Hiring Ordinance, and San Francisco Fair Chance Ordinance. **External-Facing Title:** Sr Specialist , Field Inventory (US Remote ) **Posting Country:** US - United… more
    Terumo Neuro (09/13/25)
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  • Central Authorization Specialist /Full…

    Henry Ford Health System (Troy, MI)
    …records and related documentation. + Current working knowledge of hospital operations, utilization management , case management , and managed care ... The purpose of the Central Authorization Specialist position is to centrally facilitate the successful...is obtained from back end coding, billing and denial management resources and distributed to ordering physicians and authorization… more
    Henry Ford Health System (10/09/25)
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  • Registered Nurse - Clinical Appeals & Denials…

    Cognizant (Atlanta, GA)
    …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and utilization management experience with managed health care plan . 3 years' ... **Schedule:** Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
    Cognizant (10/09/25)
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  • Clinical Education Specialist - Sonographer…

    GE HealthCare (TX)
    **Job Description Summary** The Clinical Education Specialist schedules and implements customer training and education for internal and external customers and acts ... the organization. Submits demo, schedule, and site visit information to management and updates regularly. Submits statistics, reports, and forms, including expenses,… more
    GE HealthCare (08/23/25)
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