Utilization Management Jobs in USA

IntroductionTHIS IS A NEW ASSEMBLED EXAMINATION. The eligible list resulting from thisexamination will cancel any existing list and may last approximately one yearbut can be extended.Applications must bein the possession of the Human Resource Services Department by 5:00:00 p.m. onthe Last Day for Fi...

Position SummaryThe Database Sustainment Specialist (DSS) provides comprehensive sustainment maintenance reconciliation and data integrity support for Bureau of Medicine and Surgery (BUMED) Facility Management databases and related enterprise systems. The DSS is responsible for maintaining facility...

Position SummaryThe Database Sustainment Specialist (DSS) provides comprehensive sustainment maintenance reconciliation and data integrity support for Bureau of Medicine and Surgery (BUMED) Facility Management databases and related enterprise systems. The DSS is responsible for maintaining facility...

As aPre-Auth Consultantyou will be a part of an Agile team to build healthcare applications and implement new features while adhering to the best coding development standards . Mandatory skills FACETS UM/Pre-Auth Configuration ITS/Authorization Routing Logic SQL & Rule Traceability Responsibil...

    Conducts training for staff members pertaining to Utilization Review process clinical rules/guidelines client/module/modality-specific workflows and software enhancements     Creates educational material for review tiers by collaborating with key resources across departments to ensure clinical s...

Registered Nurse (RN) Utilization ReviewLocation: Syracuse NYJob Type: 14-Week Contract Traveler or LocalShift: Day Shift (MondayFriday)Hours: 8 Hours Per DayPay Rate: $60 - $65/hourPosition OverviewWe are seeking an experienced Registered Nurse (RN) with Utilization Review and acute care experien...

DescriptionMethodist Hospital is looking to hire a RN Care Manager to join our Care Management team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day.Position Summary:The RN Care Manager provides patient-c...

OverviewHospital Name: Banner Rehabilitation HospitalPartnership with Select MedicalPosition: Case ManagerLocation: Mesa AZSchedule:Per Diem to help cover weekends and PTOCompensation: $45.00 per hourPrevious experience in Case Management and Discharge Planning from a hospital setting or SNF needed....

Inspire health. Serve with compassion. Be the difference.Job SummaryProvides primary health care to a specific patient population within the guidelines of written protocols. Follows established nursing standards procedures and practices.AccountabilitiesEngages in the diagnosis and treatment of dise...

Classification Title:Associate Chief Medical Officer (ACMO) Adult Services UF Health Greater Gainesville MarketClassification Minimum Requirements:M.D. or D.O. degree and board certification in an appropriate clinical specialty.Active medical license and current medical staff membership in good sta...

Position: Director of Case Management Location: Boston Medical Center - South (Brockton MA)Schedule: Full TimePOSITION SUMMARY:The Director of Care Management and Inpatient Social Work Services shall oversee the overall operations of Care Management functions through oversight of both daily and long...

Anticipated End Date:Position Title:Product Development Director - CarelonRx - PBMJob Description:Product Development Director - CarelonRx - PBMLocation: This role requires associates to be in-office 3 days per week fostering collaboration and connectivity while providing flexibility to support prod...

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...

Job DescriptionWere hiring an Episodic Case Manager to join the Medicare Utilization Management Team! The Episodic Care Manager is responsible for performing clinical reviews to assess facilitate and coordinate the delivery of health care services for members based on medical necessity and contrac...

DescriptionUtilization Review LPN Department: Case Management What if you had the opportunity to make a difference Carroll County Memorial Hospitals role is to improve the health and well-being of the residents and visitors to Carroll County and surrounding counties by providing quality compassionat...

Are you a proven sales leader who thrives at the intersection of cloud innovation and healthcare transformation Amazon Web Services (AWS) is seeking a Senior Sales Leader to lead our US Healthcare and Life Sciences (HCLS) Payors this role you will build lead and develop a high-performing team of Se...

The Chief Medical Officer (CMO) for the Value-Based Services Organization (VBSO) serves as a senior clinical leader supporting the advancement of value-based care across the health system. The role focuses on improving quality clinical outcomes patient experience and total cost of care across define...

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...

DescriptionWe are seeking a strategic and results-oriented Technical Program Manager (TPM) to lead the TPM function for the Enterprise Data Platform for Analytics and AI and drive the end-to-end development and implementation of high-impact technical projects and this role you will serve as a criti...

Job Family:Medical AssistantTravel Required:NoneClearance Required:NoneWhat You Will Do:Receive triage and prioritize denied hospital claims based on timely filing requirements financial impact and payer response deadlines. Conduct root cause analysis to identify clinical documentation authorization...