Utilization Management Jobs in USA

Job Title: Availity QE Lead (Claims & Provider E2E Testing)Work Location: HartfordCT6156Vendor Rate: 51.80Contract duration: 12Target Start Date: 01 Jul 2026Does this position require Visa independent candidates only YES**hybrid work set-up**Job Details:Must Have SkillsPayer provider integration w...

Job Title: Technology Specialist - IT Service Support and Operations Healthcare EDIWork Location: Hartford CT 6151Vendor Rate: $80/hrContract duration: 12monthsTarget Start Date: 04 May 2026Job Details:Must Have Skills1. Strong handson experince in HEDIS and Healthcare Qulaity pricesses(mushhave)....

Job Title: QE Lead (Enterprise Transformation Testing Broadcom Exit Program)Work Location: HartfordCT6156Vendor Rate: 58.00Contract duration: 12Target Start Date: 01 Jul 2026Does this position require Visa independent candidates only YES**hybrid work set-up**Job Details:Must Have SkillsQA Strate...

At Blue Cross and Blue Shield of Nebraska we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.Our team is the power behind that promise. And as the industry rapidly evolves and we seek ways to optimize business processes...

About Cedar Gate TechnologiesCedar Gate Technologies an IQVIA business enables payers providers employers and service administrators to excel at value-based care with a unified technology and services platform delivering analytics care and payment technology on a single data management foundation. A...

Lead with clinical expertise while empowering individuals to build stability recovery and community connection.The Therapist / Team Lead ICTS is a key clinical leader within our interdisciplinary Improving Community Treatment Success (ICTS) team. This role provides direct therapeutic services while...

Covenant Case Management Services is seeking an energetic and compassionate Qualified Professional (QP) with experience in intellectual and developmental disabilities (I/DD) to support individuals in the Raleigh this hybrid role you will help ensure high-quality service delivery build positive rela...

Find your calling at Mercy!The Care Manager as part of the interdisciplinary team assess plans advocates and coordinates care from admission to discharge ensuring a safe transition post hospitalization. Performs duties and responsibilities in a manner consistent with the Mercy mission values and se...

Inspire health. Serve with compassion. Be the difference.Job SummaryProvides assistant surgical services in the operating room as well as other selected medical services under the direction of the surgeon.AccountabilitiesProvides general surgical assistant services in operating room.10%Assists surg...

Inspire health. Serve with compassion. Be the difference.Job SummaryThe Prisma Health Physician is responsible for the provision of quality medical services to patients of Prisma Health-University Medical GroupAccountabilitiesEngages in the diagnosis prevention or treatment of disease defects or inj...

Inspire health. Serve with compassion. Be the difference.Job SummaryThe Prisma Health Physician is responsible for the provision of quality medical services to patients of Prisma Health-University Medical GroupAccountabilitiesEngages in the diagnosis prevention or treatment of disease defects or inj...

Inspire health. Serve with compassion. Be the difference.Job SummaryThe Prisma Health Physician is responsible for the provision of quality medical services to patients of Prisma Health-University Medical GroupAccountabilitiesEngages in the diagnosis prevention or treatment of disease defects or inj...

OverviewBayside Marin Treatment Center is seeking a dedicated and experienced Manager of Clinical Services to lead and support our clinical team in delivering high-quality mental health care. This role is responsible for overseeing clinical operations ensuring compliance with regulatory standards an...

OverviewRN Case ManagerMarshalltown HospitalShift: Part-Time 28 Hours per Week 8:00 AM4:30 PMIncludes occasional weekend coverage and approximately 12 holidays per year.As an RN Case Manager you will play an integral role in coordinating high-quality cost-effective patient care across the continuu...

OverviewPURPOSE STATEMENT:Proactively monitor utilization of services for patients to optimize reimbursement for the facility. ResponsibilitiesESSENTIAL FUNCTIONS:Act as liaison between managed care organizations and the facility professional clinical staff.Conduct reviews in accordance with certifi...

Anticipated End Date:Position Title:Behavioral Health Care Manager I - Overnights (After-Hours Crisis Line)Job Description:Behavioral Health Care Manager ILOCATION: This is a virtual eligible role. North Carolina residency is required.WORK HOURS: Overnights Monday-Friday OR Sunday-Thursday 11:30p-8:...

Anticipated End Date:Position Title:Behavioral Health Care Manager I - Overnights/Weekends (After-Hours Crisis Line)Job Description:Behavioral Health Care Manager ILOCATION: This is a virtual eligible role. North Carolina residency is required.WORK HOURSare rotational as follows:Week 1: Mon & Tues 1...

Job DetailsThe Healthcare Economics (HCE) teams primary function is to provide various clinical and financial analyses to management to support the business decision addition the team will provide consistent accurate reports to help management from other departments do their jobs more effectively.T...

SummaryThe Associate Director for Clinical Trial Operations and Workforce Development provides strategic and operational leadership for clinical trial activities within the Clinical and Translational Science Institute (CTSI) at the Medical College of Wisconsin (MCW). This position oversees the CTSI...

Job DescriptionPlease note that for the first six calendar days of this posting it is only open to ARW represented employees. If during the initial six days which ends on July 5 2026 a qualified ARW represented employee(s) applies it shall be awarded in accordance with Section 52.06 of the ARW Colle...