Utilization Management Jobs in USA

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...

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...

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 Title: Availity QE Lead (Claims & Provider E2E Testing)Work Location: HartfordCT6156Vendor Rate: 51.80Contract duration: 12Target Start Date: 01 Jul 2026Does this position require Visa independent candidates only YES**hybrid work set-up**Job Details:Must Have SkillsPayer provider integration w...

Job Title: Availity QE Lead (Claims & Provider E2E Testing)Work Location: HartfordCT6156Vendor Rate: 51.80Contract duration: 12Target Start Date: 01 Jul 2026Does this position require Visa independent candidates only YES**hybrid work set-up**Job Details:Must Have SkillsPayer provider integration w...

Job Title: QE Lead (Enterprise Transformation Testing Broadcom Exit Program)Work Location: HartfordCT6156Vendor Rate: 58.00Contract duration: 12Target Start Date: 01 Jul 2026Does this position require Visa independent candidates only YES**hybrid work set-up**Job Details:Must Have SkillsQA Strate...

Job Title: QE Lead (Enterprise Transformation Testing Broadcom Exit Program)Work Location: HartfordCT6156Vendor Rate: 58.00Contract duration: 12Target Start Date: 01 Jul 2026Does this position require Visa independent candidates only YES**hybrid work set-up**Job Details:Must Have SkillsQA Strate...

Requisition Number: 513885Why North Memorial Health At North Memorial Health youre part of an inclusive health team that is rooted in our values: Advocate Courageously Rally Together Respect Uniqueness and Create Impact. Empathy and care are at the heart of Norths culture which is designed to active...

City/StateCarrollton VAWork ShiftFirst (Days)Provider SpecialtyUrgent CareOverview:The Urgent Care APP (NP or PA) is responsible for the provision of health care services to individuals families and/or groups who receive their care under the auspices of Sentara Medical Group (SMG). Health care servi...

City/StateWilliamsburg VAWork ShiftFirst (Days)Overview:OverviewReporting to the division president and as a member of the division leadership team the VP Chief Medical Officer is accountable for the clinical performance improvement including the promotion of clinical appropriateness the reduction o...

Employment Type:Full timeShift:Day ShiftDescription:The Nursing Manager will have oversight of Care Management team.Why Choose Saint Joseph Health SystemAt Saint Joseph Health System our values guide every decision we make. Even when challenges arise we remain committed to our mission: caring for ev...

Job Title: Domain Testing / Program Manager PBM/Medicaid Location: Plano TX Experience Required 10 Years Job Summary We are seeking an experienced Domain Testing / Program Manager with strong expertise in Pharmacy Benefit Management (PBM) and Medicaid systems. The ideal candidate will lead...

Job Title: QA Lead (PBM/Healthcare Domain) Location: Plano TX Remote / Hybrid (As per client requirement) Experience Required 8 Years in Quality Assurance and Healthcare/PBM Domain Job Summary We are seeking an experienced QA Lead with strong expertise in Pharmacy Benefit Management (PBM) and...

A leading healthcare organization in Houston is seeking an experienced Manager of Emergency Department (ED) & Observation Case Management to provide leadership and oversight for a high-performing case management team.This leadership role is responsible for coordinating and managing daily operations...

DATE: June 23 2026POSITION: Clinical CoordinatorUtilization ManagementDEPARTMENT: Clinical ServicesRATE: $28.26 per hour with potential for additional compensation based on qualifications.POSITION SUMMARY:Performs assigned clinical functions in accordance with Upper Peninsula Health Plan (UPHP) plan...

Primary Location: Frazier Rehab Institute - UMCAddress: 220 Abraham Flexner Way Louisville KY 40202 Shift: First Shift (United States of America)Job Description Summary: UofL Health is a not-for-profit 501(c)(3) fully integrated regional academic health system with nine hospitals four medica...

Join Us in Shaping the Future of Health CareWhats in it for you:Growth opportunities to uplevel your careerA people-centric culture embracing and celebrating diverse perspectives backgrounds and experiences within our teamCompetitive compensation and comprehensive benefits focused on well-beingAn op...

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...

OverviewLead the Way as Director of Care Coordination/RNAC at Diversicare!At Diversicare were looking for a passionate Director of Care Coordination to join our exceptional team. If youre dedicated to making a difference in the lives of our patients and residents we invite you to apply.Why Lead at D...

Are you a current UMass Memorial Health caregiver Apply now through Workday.Exemption Status:ExemptHiring Range:$84011.20 - $176987.20Please note that the final offer may vary within this range based on a candidates experience skills qualifications and internal equity considerations.Schedule Detail...