Utilization Management Jobs in USA

OPEN JOB: Director of Case ManagementLOCATION:Palm Springs California**Relocation AvailableSALARY: $129000 to $200000**This position qualifies for a $20000 Sign-On Bonus!SUMMARY:The individual in this position has overall responsibility for hospital utilization management transition management and o...

Classification Title:CLIN AST/ASO/FULL PROFClassification Minimum Requirements:MD and/or PhD with subspecialty fellowship training in microbiology (ACGME or CPEP-accredited). A strong foundation in clinical/molecular microbiology (bacteriology mycology mycobacteriology parasitology virology) and lab...

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...

DescriptionJob SummaryThe Continuum of Care Coordinator (CCC) oversees the continuum of care in assigned markets for the MSSP ACOs ensuring that patients receive the highest quality of care while responsibly managing Medicare resources. The CCC is responsible for managing patient transitions between...

DescriptionThis is a remote position that requires travel within Missouri and OklahomaJob SummaryThe Continuum of Care Coordinator (CCC) oversees the continuum of care in assigned markets for the MSSP ACOs ensuring that patients receive the highest quality of care while responsibly managing Medicare...

Job Profile SummaryA vital role of the CMO Administration team the Medical Peer Reviewer plays a critical role in consulting on medical necessity in the context of utilization management and ensuring adherence to internal Healthfirst and external regulations.Duties/Responsibilities:The Medical Peer...

Primary Location: Med Plaza II - UMCAddress: 250 E Liberty Louisville KY 40202 Shift: First Shift (United States of America)Job Description Summary: Manage team of 10-12 clinical reviewers and oversee Facility clinical claim denials by developing strategies to overturn insurance payor proces...

Hi were Oscar. Were hiring a Senior Analyst UM Regulatory Operations to join our UM Regulatory Operations team.Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of healt...

Job Description: Summary:This position assists the Chief Medical Director to direct and coordinate the medical management quality improvement and credentialing functions for the business unit. This role supports the HARP line of business. Essential Accountabilities:Level IProvides medical leadership...

Job Title: LMSW / RN Case ManagementLocation: Everett WA 98201 Assignment: 12-Week Contract (Temp-to-Hire)Schedule:Day Shift: 07:30 AM 04:00 PMMondayFriday (5x8) Every Other WeekendPosition SummaryNavitas Healthcare LLC is seeking an experienced LMSW or RN Case Manager to support acute care opera...

AHCCCSArizona Health Care Cost Containment SystemAccountability Community Innovation Leadership Passion Quality Respect Courage TeamworkThe Arizona Health Care Cost Containment System (AHCCCS) Arizonas Medicaid agency is driven by its mission to deliver comprehensive cost-effective health care to Ar...

OverviewAbout the Role:The primary purpose of the Case Management Coordinator position is to coordinate the patients progress through the system. He/she collaborates with physicians and clinical staff to ensure resource utilization is appropriate to the patients clinical and psychosocial needs and t...

OverviewAbout the Role:The primary purpose of the Case Management Coordinator position is to coordinate the patients progress through the system. He/she collaborates with physicians and clinical staff to ensure resource utilization is appropriate to the patients clinical and psychosocial needs and t...

OPEN JOB: Manager Care Management - Social WorkLOCATION:Everett WashingtonSALARY: $133000 to $178630Relocation Assistance Available The Manager Care Management is responsible for the daily management and organization of all activities and staff within the Care Management Department including care co...

Principal Healthcare AI and AutomationInfosys Consulting isseekinga highly skilled and experienced Principal with a strong focus onAI enabledHealthcare transformation across payers and provider health leadership role requires a professional with a proventrack recordin healthcare business consultin...

OverviewHospital Name: OhioHealth Rehabilitation HospitalJoint venture/Partnership/Affiliation with Select MedicalPosition: Case Manager (RN)Location: Columbus OHSchedule: FulltimeCompensation: $70000 - $98000 per yearOur Inpatient Rehabilitation Hospital is committed to providing exceptional and co...

OverviewHospital Name: OhioHealth Rehabilitation Hospital - DublinJoint venture/Partnership/Affiliation with Select MedicalPosition: Case Manager (Registered Nurse)Location: Dublin OhioSchedule: FulltimeCompensation: $70000 - $98000 per yearOur Inpatient Rehabilitation Hospital is committed to provi...

We are recruiting for a mission-driven Manager Care Management Transition of Care Team - Denver Health Medical Plan 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. Our ValuesRespect Belon...

OPEN JOB: Director Care (Case) Management LOCATION:Olympia Washington***Relocation Assistance AvailableSalary: $150000 to $220000IDEAL CANDIDATE:An R.N. that led Case Management in an acute care setting for more 3 yearsThe Role:Under the supervision of the North Division Executive Director of Care M...

We are recruiting for a mission-driven Manager Care Management Transition of Care Team - 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 e...