Utilization Review Jobs in USA

DescriptionJOB DESCRIPTION: The Social Work Care Manager (PRN) is responsible for patient care coordination from admission through discharge; ensuring smooth transitions of care as the patient is discharged from the hospital setting ensuring and facilitating high quality clinical and cost outcomes p...

About Us: The people of Memorial Sloan Kettering Cancer Center (MSK) are united by a singular mission: ending cancer for life. Our specialized care teams provide personalized compassionate expert care to patients of all ages. Informed by basic research done at our Sloan Kettering Institute scienti...

FTE: Full time-9:00 a.m.-5:00 p.m.WE ARE INSIGHT: At Insight Hospital and Medical Center Chicago we believe there is a better way to provide quality healthcare while achieving health equity. Our Chicago location looks forward to working closely with our neighbors and residents to build a full-servic...

Full-timeDescriptionAt Signature Health our purpose is to provide integrated healthcare for our community specializing in patients with mental illness and/or addiction because we want people to realize their highest potential. If you align with our core values putting people first striving for excel...

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care of assigned patients and associated staff in accordance with physician orders and the plan of care per state Practice this role you will report to the Director of Nursing/Director of Patient Care Servi...

REQUEST FOR PROPOSALSIssued: June 2026Medi-Cal Billing Infrastructure ConsultantCompass Family Services Compass Behavioral Health Services (CBHS)The OpportunityCompass Family Services is a nonprofit organization dedicated to assisting San Francisco families who are homeless or at-risk of homelessnes...

Anticipated End Date:Position Title:Med Mgmt Nurse CAJob Description:Medical Management NurseHours: Monday - Friday 8am to 5pm PSTLocation: Candidates must reside in the state of CaliforniaThis role enables associates to work virtually full-time with the exception of required in-person training sess...

Primary City/State:Phoenix ArizonaDepartment Name: Wound Care-OP-HospWork Shift: DayJob Category:Clinical CareNursing careers are better at Banner Health. Weve built smarter processes to help nurses focus on what really matters. If you want to make a difference in peoples lives - this could be the o...

Position Title: Full-time Care Navigator Medical AssistantLocation: 200 W. Douglas Ste. 900 Wichita KS 67202 - Applicant must be able to work on-siteDepartment: Integrated Health ManagementReports To: Case Manager/Director of Integrated Health ManagementEmployment Type: Full-timeHours: 10a 7p th...

    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...

DescriptionJob Title:Utilization Review DirectorJob Type: Onsite Full-timePay rate:$$110000 -$148000Work Schedule: Monday-Friday 8am-5pm MSTYour experience matters Denver SpringsAt Denver Springs we are committed to empowering and supporting a diverse and determined workforce who can drive quality s...

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...

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...

PRINCIPLE RESPONSIBILITIESProvide review and evaluation of utilization data for areas of improvement for both clinical impact and cost effectiveness of the pharmacy program for renewals.Analyze monthly claims data and provide client feedback to Client Services/Sales as needed.Ensure appropriate qual...

Job Description SummaryUtilizing a collaborative approach the Case Manager will assess plan implement monitor and evaluate the options and services required to meet an individuals health needs. Provides comprehensive on-going case management services to patients by coordinating and managing the care...

Current Employees:If you are a current Staff Faculty or Temporary employee at the University of Miami please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position please review this tip sheet.CORE JOB SUMMARYThe Critical Care T...

The Clinical Care Management Specialist/Integrated Care Specialist provides clinical recommendations and collaborative support to team members and physical health care staff involved in the Integrated Care Plan (ICP) Program.The Clinical Care Management Specialist reviews clinical information using...

Anticipated End Date:Position Title:Quality Auditor Hospital Bill Audits & Itemized Bill Review (Program Integrity)Job Description:Location: Norfolk VA Mason OH Indianapolis IN Louisville KY Atlanta GA Miami FL Grand Prairie TX Overland Park KSHours: Standard Working hoursTravel: This role requires...

Anticipated End Date:Position Title:Medical Director - Medicare Fee for ServiceJob Description:Medical Director- Medicare Fee for ServiceLocation: This role enables associates to work virtually full-time with the exception of required in-person training sessions providing maximum flexibility and au...

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...