Utilization Management Jobs in USA

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...

The Behavioral Health Liaison supports CBH Clinical Care Managers in the proper procurement of behavioral health services of CBH members. The Behavioral Health Liaison supports utilization management by monitoring services to ensure approved services are being delivered as authorized and are best me...

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...

The Behavioral Health Liaison supports CBH Clinical Care Managers in the proper procurement of behavioral health services of CBH members. The Behavioral Health Liaison supports utilization management by monitoring services to ensure approved services are being delivered as authorized and are best me...

St. Lukes is proud of the skills experience and compassion of its employees. The employees of St. Lukes are our most valuable asset! Individually and together our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the...

Its more than a career its a callingMO-SSM Health St. Joseph Hospital - Lake Saint LouisWorker Type:PRNJob Highlights:PRN Position scheduled hours would be Monday through Friday 8:00 AM to 4:30 PM with weekend shifts required as needed.Requirement of three years acute care experience and a preferenc...

Summary Description:The Hospital Case Manager is a registered professional nurse who facilitates and enhances collaboration with patients families physicians and healthcare providers to ensure patients receive the services required to improve healthcare outcomes and quality of life. The Hospital Cas...

Job DetailsWorks with minimal supervision to ensure that comprehensive quality cost effective patient care is offered for members in need of care coordination. Review medication profiles verify appropriate testing and facilitate office visits with primary care and specialist physicians for members...

OverviewBe inspired. Be rewarded. Belong. At Emory Healthcare.At Emory Healthcare we fuel your professional journey with better benefits valuable resources ongoing mentorship and leadership programs for all types of jobs and a supportive environment that enables you to reach new heights in your care...

Anticipated End Date:Position Title:LTSS Service CoordinatorJob Description:LTSS Service Coordinator Schedule: Monday-Friday 8am-5pm CSTLocation: This is primarily a field based position. Candidate would need to reside in one of the following counties: Val Verde Zavala Dimmit Uvalde Ector Midland Ta...

Anticipated End Date:Position Title:LTSS Service Coordinator (Hardin and Polk County)Job Description:LTSS Service Coordinator Schedule: Monday-Friday 8am-5pm CSTLocation: This is primarily a field based position. Candidate would need to reside in one of the following counties: Hardin and Polk County...

Anticipated End Date:Position Title:LTSS Service Coordinator (Llano and Mason County)Job Description:LTSS Service Coordinator Schedule: Monday-Friday 8am-5pm CSTLocation: This is primarily a field based position. Candidate would need to reside in one of the following counties: Llano and Mason County...

Anticipated End Date:Position Title:Medical Management Clinician SeniorJob Description:Medical Management Clinician Senior Location: Candidates are required to reside in the state of Florida. This role enables associates to work virtually full-time except for required in-person training sessions pro...

Position SummaryLincoln County Health and Human Services is looking for a Behavioral Health Division Director to join their team to assist with shaping and supporting the future of the division and the well-being of the community at large.$$148836.00 annually**Lincoln County follows Oregon Pay Equit...

Job Description: Summary:Conducts case management program activities in accordance with departmental corporate NYS Department of Health (DOH) Centers for Medicaid & Medicare Services (CMS) Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards as a...

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...

SummaryWe are currently hiring for a Managed Care Coordinator II Utilization Management to join BlueCross BlueShield of South this role as a Managed Care Coordinator II Utilization Management you will review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria b...

Registered Nurse (RN) Case Management / Utilization ReviewLocation: Hyannis MA 02601Duration: 27 WeeksShift: Day ShiftHours: 40 Hours Per WeekSchedule: Monday Friday 8-Hour ShiftsOn-Call: Rotating Weekend and Holiday Coverage RequiredWe are seeking an experienced Registered Nurse (RN) with a stro...

About CurativeCurative is building the future of health insurance with a first-of-its-kind employer-based plan designed to remove financial barriers and make care truly accessible: one monthly premium with $0 copays and $0 deductibles*. Backed by our recent $150M in Series B funding and valuation at...

Scope of work: Provides health information interacts and acts as a resource for providers for complex clinical situations to ensure appropriate use of preservice and concurrent acute medical and/or behavioral health care services. Assesses appropriateness of preservice and concurrent requests for ad...