Utilization Review Jobs in USA

Description Summary Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional n...

Utilization Management Physician (UMP)Full-Time Remote Florida License RequiredWe are seeking a Utilization Management Physician (UMP) for a full-time remote opportunity with a well-established multi-specialty healthcare organization in Florida. This role requires strong clinical judgment critical...

Anticipated End Date:Position Title:National Accounts Medical DirectorJob Description:National Accounts Medical Director Location: This role enables associates to work virtually full-time with the exception of required in-person training sessions providing maximum flexibility and autonomy. This appr...

DescriptionJob SummaryCase Managers will apply systems science incentives and information to improve healthcare practice and assist patients and their support systems to become engaged in a collaborative process designed to manage medical/social/mental health conditions more effectively. The case ma...

DescriptionJob SummaryCase Managers will apply systems science incentives and information to improve healthcare practice and assist patients and their support systems to become engaged in a collaborative process designed to manage medical/social/mental health conditions more effectively. The case ma...

DescriptionJob SummaryCase Managers will apply systems science incentives and information to improve healthcare practice and assist patients and their support systems to become engaged in a collaborative process designed to manage medical/social/mental health conditions more effectively. The case ma...

Location:Eagles Trace by Erickson Senior LivingJoin our team as the Assistant Director of Nursing is responsible for clinical leadership and outcomes within our Skilled Assisted Living and Memory Care neighborhoods.What we offer A culture of diversity inclusion equity and belonging which builds on o...

Associate Chief Medical Officer (ACMO)Full-Time Leadership OpportunityA large multi-specialty healthcare organization is seeking an experienced Associate Chief Medical Officer (ACMO) to join its executive leadership team. This key leadership role is responsible for overseeing the daily operations o...

Location:Eagles Trace by Erickson Senior LivingJoin our team as the Assistant Director of Nursing is responsible for clinical leadership and outcomes within our Skilled Assisted Living and Memory Care neighborhoods.What we offer A culture of diversity inclusion equity and belonging which builds on o...

Job Title: RN Case Manager (Care Coordinator) Location: Tallahassee FL Shift: Evening Shift (12:00 PM 8:30 PM EST) Schedule: 1 weekend per 4-week rotation Employment Type: Full-TimeCompensation & IncentivesBase Pay: $31.94 $43.92 per hour (based on experience)Shift Differentials:Evening Shift: $2....

DescriptionPosition Summary: Provide operational leadership toindividual contributors and hourly workforce to ensure the execution of daily tasks and activities including driver deliveries loading/unloading of trailers cross docking and customer service operations in a manner consistent with company...

DescriptionPosition Summary: Provide operational leadership toindividual contributors and hourly workforce to ensure the execution of daily tasks and activities including driver deliveries loading/unloading of trailers cross docking and customer service operations in a manner consistent with company...

The Manager Acute Care Services is responsible for the operational administrative and people leadership of COPCs Same Day Centers and Pediatric Support Centers. These Centers extend primary care access during evenings and weekends providing timely high-quality acute care while reducing unnecessary E...

Answer the call to leadership as a Registered Nurse Case Manager in Juneau Alaska where compassionate coordination becomes the bridge between patients goals and sustainable this role youll guide complex care journeys navigate scarce resources and empower families with clarity an...

ENL Case ManagementCompensation range:$57.13 - $77.13Your rate of pay will be based on applicable experienceShift: Days Days off: Variable one weekend shift per week is required Hours per pay period: 60S...

Step into a pivotal role as a Registered Nurse Case Management in Honolulu Hawaiia multi-week assignment that positions you at the heart of patient-centered care. Youll shape outcomes by weaving together hospital care community resources and family engagement to create seamless t...

Location:Avera Health PlansWorker Type:RegularWork Shift:Primarily days with possible weekends/evenings/holidays (United States of America)Position HighlightsYou Belong at AveraBe part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. W...

Embark on a transformative journey as a Registered Nurse Case Management specialist in Olympia Washington with opportunities across select locations nationwide. Starting 03/10/2026 for a flexible week-based assignment with extension potential this role invites you to apply your c...

Employment Type:Full timeShift:Day ShiftDescription:Position Purpose:The Financial Counselor is responsible for meeting with patients/guarantors who require assistance in seeking and applying for healthcare funding (e.g. Charity Care Medicaid or other local/governmental funding program) and/or requi...

As Medical Director - Utilization (UM) at Astrana Health you will 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 that bridges...