Utilization Management Jobs in USA

Evening Shift ONLY: Monday - Friday 4pm - 12amThe Clinical Care Manager is responsible for utilization management by conducting utilization review activities population management cross-system consultation provider management and treatment quality monitoring.The Clinical Care Manager must utilize cl...

OverviewSelect Medical Rehabilitation HospitalMiami Lakes Florida**NEW HOSPITAL OPENING: AUGUST 2026**Case Manager (RN SW RT)Full Time Days (M-F 8a-5p)No Weekends Or Major HolidaysPay Is Determined By Previous Years Of Relevant ExperienceWhy Join UsStart Strong: Extensive and thorough orientation pr...

The Clinical Care Manager (CCM) Specialist- Childrens Complex Care (High-Fidelity Wraparound) is part of a specialized team responsible for providing high intensity care management that works collaboratively and directly with members and providers to ensure effective holistic member-centric care.The...

Employment Type:Full timeShift:Day ShiftDescription:Utilizes advanced coding and/or clinical expertise to direct efforts toward the improvement of clinical documentation through the roles of educator and consultant. Facilitates improvement in the overall quality completeness and accuracy of medical...

Employment Type:Full timeShift:Description:Social Worker for Mount Carmel Grove City Position Purpose:The Social Worker intervenes with patients who have complex psychosocial needs require assistance with eligibility determination for social programs and funding sources and qualify for community ass...

Our CompanyRehab in MotionOverviewThe Outpatient Site Manager (Rehab in Motion) is directly responsible for managing the business and clinical operations of assigned treatment facility. The Site Manager assures care and services provided by the team are in compliance with state and federal regulator...

Our CompanyAdoration HealthOverviewThe Outpatient Site Manager (Rehab in Motion) is directly responsible for managing the business and clinical operations of assigned treatment facility. The Site Manager assures care and services provided by the team are in compliance with state and federal regulato...

ATTENTION MILITARY AFFILIATED JOB SEEKERS- Our organization works with partner companies to source qualified talent for their open roles. The following position is available toVeterans Transitioning Military National Guard and Reserve Members Military Spouses Wounded Warriors and their Caregivers. I...

The Sr Project Manager Clinical Transformation (Sr PM) uses their deep knowledge of clinical operations business processes regulations and technology to lead large-scale complex initiatives focused on the implementation of Utilization Management (UM) Care Management (CM) and related clinical operati...

SummaryThe Compliance Program Manager is responsible for the development implementation and ongoing monitoring of the Corporate Compliance Program with a particular emphasis on federal payor billing compliance and compliance-related education for the Johns Hopkins Health System Corporation and its a...

DescriptionRegistered Nurse (RN) Joint Program CoordinatorJob Type: Full-Time DaysSchedule: 5x8s 8:00am-5:00pmYour experience mattersSaline Memorial Hospital is part ofLifepoint Health a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment t...

Anticipated End Date:Position Title:Medical Management Nurse (US)Job Description:Medical Management NurseHours: Monday- Friday 8am- 5pm CST some holidays may be required*Candidate must reside in Missouri*Location: This role enables associates to work virtually full-time with the exception of require...

Psychiatric Mental Health Nurse PractitionerFull Job DescriptionCommunity Bridges Inc. (CBI) is an integrated behavioral healthcare agency offering a variety of different programs throughout Arizona. CBI provides residential outpatient inpatient patient-centered medical homes medication-assisted tre...

Who We ArePoint32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality affordable healthcare. Serving nearly 2 million members Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and em...

Psychiatric Mental Health Nurse Practitioner (PT Onsite PMHNP for ages 15 and up predominately adults.) Community Bridges INCThe schedule is Mon/Wed/Friday Job DescriptionCommunity Bridges Inc. (CBI) is an integrated behavioral healthcare agency offering a variety of different programs throughout A...

Position/Program InformationEXAM NUMBERY4608H-DOJTYPE OF RECRUITMENTOPEN COMPETITIVE -EMERGENCYFIRST DAY OF FILING:The application filing period will begin on June 15 2026 at 8:00 a.m. (PT)and will remain open on a continuous basis. Applications will be accepted until the positions are filled. Pleas...

ID: Shift: Day 5x8-Hour (08:00 - 17:00) Description: **REDUCED Non-Billable Orientation (NBO) Job - 0 Hours NBO vs. Standard 40 NBO**Pharmacy Tech Role**OR PHARM TECH LIC REQUIRED** **MUST have advanced Excel skills. Do not submit without ADVANCED EXCEL. On call 2-3 weekends per year. This position...

Site: The Brigham and Womens Hospital Inc.Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service st...

If you are a current State of Maine employee please submit your application through the internal application process using the Find Jobs report in PRISM. Seasonal employees who do not have PRISM access should apply through the States career page and indicate on the application that they have previou...

Registered Nurse (RN) Clinical Supervisor / Nurse Manager Home CareWichita KS Area Full-Time or Part-Time Office & Field-BasedCompensation: $75000 $95000 annually (Full-Time)Part-time and PRN arrangements may also be considered based on experience and availability.BenefitsHealth InsuranceDental...