Utilization Management Jobs in USA

Job Description: This position is responsible for coordinating integrating and monitoring the utilization of behavioral health (BH) or physical health (PH) services for members ensuring compliance with internal and external standards set by regulatory and accreditation entities. Refers appropriate c...

About the RoleThe PartTime Medical Director Utilization Management Outpatient Services provides physician oversight for medical necessity appropriateness and utilization decisions across Astrana Healths outpatient ancillary and professional services. This role supports Astranas delegated risk arran...

Anticipated End Date:Position Title:Utilization Management Representative II - Benefit InvestigationJob Description:Utilization Management Representative II - Benefit InvestigationVirtual: This role enables associates to work virtually full-time except for required in-person training sessions provi...

Site: Mass General Brigham Health Plan Holding Company 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 com...

Site: Mass General Brigham Health Plan Holding Company 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 com...

Job Title: Senior AI & Utilization Management Product Manager Track: Individual Contributor (IC) Experience: 7 - 10 years Department: Product Management Location: Care Lumen Remote (US Only) Reports to: Manager or Senior Manager Product Management Salary Range: $150000 - $181000 Bonus (if applica...

Site: Mass General Brigham Health Plan Holding Company 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 com...

Astrana is seeking a California-licensed Medical Director - Utilization (UM) to provide clinical oversight and strategic leadership through our utilization review operations to ensure members receive high-quality medically appropriate and cost-effective care. This is a critical cross-functional role...

Astrana is seeking a California-licensed Medical Director - Utilization (UM) to provide clinical oversight and strategic leadership through our utilization review operations to ensure members receive high-quality medically appropriate and cost-effective care. This is a critical cross-functional role...

We are recruiting for a mission-driven Senior Director Health Plan Utilization Management - Denver Health Medical Plan (* Hybrid Work Schedule *) to join our team!Were with you for lifes journey. At Denver Health purpose isnt just something we believe inits something we live every day for lifes jour...

We are recruiting for a mission-driven RN Clinical Trainer Utilization Management - Denver Health Medical Plan (* Must Reside in Colorado *) to join our team!Were with you for lifes journey. At Denver Health purpose isnt just something we believe inits something we live every day for lifes journey....

We are recruiting for a mission-driven RN Clinical Trainer Utilization Management - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement) to join our team!Were with you for lifes journey. At Denver Health purpose isnt just something we believe inits something we live every...

We are recruiting for a mission-driven Senior Director Health Plan Utilization Management - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement)) to join our team!Were with you for lifes journey. At Denver Health purpose isnt just something we believe inits something we li...

Title: Resource Utilization Coordinator - Outcome ManagementDepartment Org: Outcome Management - 110040Employee Classification: B5 - Unclass Full Time AFSCME HSCBargaining Unit:AFSCME HSCPrimary Location: HSC HShift:1Start Time:7:00am End Time:5:30pmPosted Salary: $32.81 - $42.58Float: TrueRotate: T...

DescriptionAs a Licensed Practical Nurse at North Okaloosa Medical Center youll play a vital role in doing what you do best - providing quality care to our patients. Our nurses enjoy a robust benefits package including health insurance 401(k) flexible scheduling 100% licensure/certification reimburs...

DescriptionAs a Licensed Practical Nurse at North Okaloosa Medical Center youll play a vital role in doing what you do best - providing quality care to our patients. Our nurses enjoy a robust benefits package including health insurance 401(k) flexible scheduling 100% licensure/certification reimburs...

DescriptionAs a Licensed Practical Nurse at North Okaloosa Medical Center youll play a vital role in doing what you do best - providing quality care to our patients. Our nurses enjoy a robust benefits package including health insurance 401(k) flexible scheduling 100% licensure/certification reimburs...

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...

About the RoleThe Inpatient Medical Director provides physician leadership across Astrana Healths hospital partners ensuring highquality costeffective inpatient care aligned with Astranas valuebased and population health strategies. This leader partners closely with hospitalists specialists care man...

Remote Admissions Coordinator Long-Term Care & Rehabilitation (RN or LPN)** This position has local travel / field visits **This position includes occasional local travel / field visitsLocation: Remote Must reside in New Hampshire with occasional local travel to hospitals and skilled nursing facil...