JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes
Hi, were Oscar. Were hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective
Relief, Days Pay range: $27.74 - $41.61 ST. CHARLES HEALTH SYSTEM JOB DESCRIPTION TITLE: Utilization Review Specialist REPORTS TO POSITION: Manager - Utilization Management DEPARTMENT: Utilization Management DATE LAST REVIEWED: August 2025 OUR VISION: Creating America’s healthiest community, together OUR
JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through
Work From Home Work From Home Work From Home, Indiana 46544 The Utilization Review Coordinator performs admission screening for patients in a bed for medical necessity, and reviews for appropriateness of setting and utilization. WHO WE ARE With 11 ministries
Job DetailsJob Location: Huntington Beach Office - Huntington Beach, CA 92647Position Type: Full TimeSalary Range: $34.98 - $42.85 HourlyRemote in California onlyAre you ready to make a lasting impact and transform the healthcare space? We are
Job Posting Gross Pay (weekly): $2210.0 Taxable Pay (weekly): 680.0 Non-taxable Pay (weekly): 1530.0 Shift: Type - 8hr Days, Schedule - No schedule available Location: Fort Myers, FL Scheduled Hours: 40...
Utilization Review Specialist The Utilization Review Specialist is responsible for the assessment and review of the healthcare delivery system with a concentration on tasks that promote cost-effective quality care and cost containment in accordance with various federal and/or state statutes, regulations
Utilization Review Nurse Join Martins Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of people caring for people, Martins Point employees
Job Title Plays a critical role in ensuring that patients receive high-quality care while efficiently utilizing medical resources. Job Description Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in
Utilization Review Nurse Join Martins Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of people caring for people, Martins Point employees
Director of Utilization Management The Director of Utilization Management (UM) is responsible for leading and managing the Utilization Management (UM) functions at Northeast Georgia Medical Center. This position plays a critical role in ensuring correct status assignment, optimizing reimbursement,
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs. This position focuses on
At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We
Opportunities with ProHealth Physicians, part of the Optum family of businesses. When you work at ProHealth Physicians, your contributions directly sustain the health and well-being of our community. Discover high levels of teamwork, robust medical resources
Become a part of our caring community The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting data, criteria, policies, and procedures to provide the best and most appropriate treatment,
Posting Date07/06/2026 1991 Industrial Dr, Deland, Florida, 32724-2039, United States of America As a DaVita Integrated Kidney Care Registered Nurse (RN) Case Manager you will support some of our most complex patients, assisting them in navigating a
The Role: The Clinical Quality Specialist (RN) is a nurse who helps ensure the quality, safety, and value of the member journey at Included Health. This role focuses on how members experience care across all touch points—virtual
The Manager of Utilization Management provides daily oversight for Case Management teams (which includes RN’s, Social Workers, and Coordinators). The Manager of Utilization Management is responsible for ensuring high quality, cost-effective, and appropriate allocation of member services, treatments, and