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Remote Remote permanent
LeadershipTeam ManagementPolicy DevelopmentData AnalysisProcess OptimizationReportingContract ManagementRegulatory ComplianceQuality ImprovementStaff Recruitment

About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: • Capital Rx, a public benefit corpor...

April 3, 2026 View Details

Utilization Review Specialist

The Recovery Village

United States Remote permanent
CommunicationInsurance KnowledgePatient CareData EntryRecords ManagementAppeals ProcessRegulatory ComplianceTime ManagementCollaborationDocumentation

We are looking for a Remote Utilization Review Specialist Advanced Recovery Systems is an integrated behavioral healthcare management company dedicated to the treatment of addiction, substance abuse,...

April 1, 2026 View Details

RN Case Manager / Utilization Review

Greenlife Healthcare Staffing

Syracuse, New York, United States permanent
Patient CareEPICUtilization ReviewDischarge PlanningInterdisciplinary CoordinationComplianceResource Utilization AnalysisED Case Management

RN Case Manager / Utilization Review - Syracuse, NY (#25268) • Location: Acute Care/Academic Medical Center, Syracuse, NY • Employment Type: Full-time • Hourly Rate: $65/hour About Greenlife Healthc...

March 10, 2026 View Details
Remote (Remote (Texas)) Remote permanent
Utilization ReviewNurse ManagementOffshore Team LeadershipQueue ManagementRegulatory CompliancePerformance MonitoringClinical TrainingVendor ManagementWorkforce OptimizationClinical Auditing

Hi, we're Oscar. We're hiring a Utilization Review Nurse, BPO Supervisor to join our team. Oscar is the first health insurance company built around a full stack technology platform and a relentless f...

March 29, 2026 View Details
Chicago, IL, United States Remote permanent
Clinical Care ManagementUtilization ReviewPatient CareRegulatory KnowledgeClinical DocumentationCollaborationCare CoordinationComplianceQuality ImprovementProfessional Development

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

March 16, 2026 View Details
St. Louis, MO, United States Remote permanent
Clinical Care ManagementUtilization ReviewRegulatory KnowledgeClinical DocumentationCommunicationCollaborationComplianceQuality ManagementProfessional Development

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

March 2, 2026 View Details

Utilization Nurse

Confidential

Irving, New York permanent
Patient CareEMR SystemsHIPAAUtilization ReviewPost-Discharge Follow-upCare CoordinationDischarge PlanningQuality ImprovementReadmission PreventionEvidence-Based Guidelines

BASIC FUNCTION: Incumbent is responsible for providing professional nursing care to, and performing case management duties for, patients of the Seneca Nation Health System (SNHS) in accordance with ...

March 27, 2026 View Details

Utilization Nurse

Confidential

Salamanca, New York permanent
Patient CareEMR SystemsHIPAAUtilization ReviewCare CoordinationDischarge PlanningMedication ReconciliationSocial Determinants of HealthQuality ImprovementPost-Discharge Follow-up

BASIC FUNCTION: Incumbent is responsible for providing professional nursing care to, and performing case management duties for, patients of the Seneca Nation Health System (SNHS) in accordance with ...

March 27, 2026 View Details
Remote Remote permanent
Patient CareUtilization ReviewMedical TerminologyEMR SystemsHIPAAActive ListeningMotivational InterviewingCodingDischarge PlanningVirtual Work Environment

Evry Health is seeking a tech-savvy Nurse to join our team. This is an exciting role allowing the ability to work with members across the continuum with ~75% utilization review and ~25% care coordinat...

March 23, 2026 View Details
Santa Rosa, California, United States permanent
Patient CareMedical TerminologyHIPAAEMR SystemsMedicareMedicaidMedical NecessityRecordkeepingCollaborationManage Care

ABOUT US: Formerly Aurora Santa Rosa Hospital, SRBHH was opened in 2016 and is regarded as an integral part of the greater Santa Rosa and Northern California mental health system of care. Convenientl...

March 20, 2026 View Details
McHenry, IL, United States permanent
Registered NursePatient CareMedical KnowledgeHospital ProceduresUtilization ReviewAdmission DocumentationPayor CollaborationClinical Data AnalysisChange AgentLength of Stay Optimization

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As...

March 18, 2026 View Details
Lake Forest, IL, United States permanent
Patient CareEMR SystemsHIPAAMedical TerminologyQuality AnalysisMedicare Regulations

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As...

March 11, 2026 View Details
Milwaukee, WI, United States Remote permanent
Clinical Care ManagementUtilization ReviewPatient CareComplianceQuality AssuranceDocumentationCollaborationCommunicationRegulationsProfessional Development

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

March 2, 2026 View Details
Iowa City, IA, United States Remote permanent
Clinical Care ManagementUtilization ReviewClinical DocumentationCollaborationComplianceQuality AssuranceRegulatory KnowledgeCommunicationCare CoordinationProfessional Development

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

March 2, 2026 View Details
Albany, NY, United States contract
Customer ServiceAnalytical SkillsCommunication SkillsClinical IntakeBenefit Application AssistanceReferral ProcessingPOS SystemsHIPAA ComplianceIndependent WorkerTime Management

Mindlance is a national recruiting company which partners with many of the leading employers across the country. Feel free to check us out at http://www.mindlance.com. MAJOR JOB DUTIES AND RESPONSIBI...

May 27, 2016 View Details

Utilization Management Professional

IntegratedResourcesINC

Miami, FL, United States contract
Clinical KnowledgeData AnalysisMedical DocumentationRegulatory ComplianceTransition PlanningCollaborationDischarge PlanningCase ManagementDecision SupportBenefit Education

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integri...

April 12, 2017 View Details

Utilization Management Professional

IntegratedResourcesINC

Brooklyn, NY, United States permanent
Clinical AnalysisRegulatory ComplianceData AnalysisCommunication SkillsTime ManagementTeam CollaborationPatient AdvocacyElectronic DocumentationGeriatric CareUtilization Management

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and...

August 15, 2017 View Details

Utilization Management CNA

Cottinghambutlerinsuranceservicesinc

Davenport, Iowa, United States (Dubuque, IA) Remote permanent
CommunicationCustomer ServiceDetail OrientedCNAHIPAA

Utilization Management Assistant Location: Onsite in Dubuque, IA. Also accepting remote applicants. Are you passionate about patient care and thrive in a fast-paced, professional environment? We are...

March 6, 2026 View Details

Utilization Management Assistant

Cottinghambutlerinsuranceservicesinc

Des Moines, Iowa, United States (Dubuque, IA) Remote permanent
CommunicationCustomer ServiceDetail OrientedMedical TerminologyHIPAAEMR Systems

Utilization Management Assistant Location: Onsite in Dubuque, IA. Also accepting remote applicants. Are you passionate about patient care and thrive in a fast-paced, professional environment? We are...

March 6, 2026 View Details
Remote (Louisville HQ) Remote permanent
Strategic LeadershipClinical GovernanceOperational OversightProcess ExcellenceTechnology EnablementAutomationData AnalysisRegulatory ComplianceFinancial ImpactClient Experience

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, st...

March 4, 2026 View Details
Remote Remote permanent
Pharmacy PracticeTraining DevelopmentInstructional DesignContent CreationRegulatory CompliancePerformance EvaluationData AnalysisPrior AuthorizationOutreach material preparation

About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: • Capital Rx, a public benefit corpor...

March 4, 2026 View Details

Utilization Review Specialist

Compasshealthcenter

Remote (Virtual) Remote permanent
Insurance AuthorizationCommunicationClinical DocumentationEMR SystemsPatient AdvocacyMedical TerminologyTime ManagementTeam CollaborationCritical ThinkingMicrosoft Office

Weekly outpatient therapy isn't always enough, and a trip to the ER isn't the only answer. Patients and their families rely on Compass Health Center when in crisis – every day, we help people overcome...

March 4, 2026 View Details
Not specified permanent
Clinical ServicesSingle Case AgreementsClinical TeamsTraining and EducationClient AdvocacyPreauthorizationContinued Authorizations

Utilization Review Specialist Department: Clinical Services Location: Remote Reports To: Clinical Director FLSA Designation: Exempt JOB SUMMARY: The Utilization Review Specialist is responsible for ...

March 3, 2026 View Details
Springfield, IL, United States Remote permanent
Clinical Care ManagementUtilization ReviewClinical Decision MakingDocumentationCommunicationCollaborationComplianceQuality ImprovementProfessional Development

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

March 2, 2026 View Details
Chicago, IL, United States Remote permanent
Clinical Care ManagementUtilization ReviewPatient CareRegulatory ComplianceClinical DocumentationCollaborationCare CoordinationCollaborator SupportComplianceProfessional Development

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

March 2, 2026 View Details
Gary, IN, United States Remote permanent
Clinical Care ManagementUtilization ReviewClinical DocumentationPatient CareComplianceQuality ImprovementCollaborationCommunicationRegulatory Knowledge

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

March 2, 2026 View Details
Monroe, WI, United States Remote permanent
Clinical Care ManagementUtilization ReviewClinical DeterminationsMedical DocumentationCommunicationCollaborationComplianceQuality ManagementProfessional Development

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

March 2, 2026 View Details
Freeport, IL, United States Remote permanent
Clinical Care ManagementUtilization ReviewClinical DocumentationCommunicationCollaborationComplianceQuality AssuranceProfessional Development

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

March 2, 2026 View Details
Hammond, IN, United States Remote permanent
Clinical Care ManagementUtilization ReviewMedical CodingPatient CareRegulatory ComplianceClinical CollaborationCare CoordinationDocumentationComplianceProfessional Development

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

March 2, 2026 View Details
Hammond, IN, United States Remote permanent
Clinical Care ManagementUtilization ReviewClinical DocumentationRegulatory KnowledgeCollaborationCommunicationComplianceQuality ImprovementData Analysis

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

March 2, 2026 View Details
Remote, United States (Remote) Remote permanent
Utilization ReviewInsuranceCommunicationInterpersonalProject Management

Why Charlie Health? Millions of people across the country are navigating mental health conditions, substance use disorders, and eating disorders, but too often, they’re met with barriers to care. Fro...

March 2, 2026 View Details
Springville, Utah, United States Remote permanent
Clinical JudgmentPsychiatric Behavioral HealthComplianceMedical Necessity CriteriaPrior Authorization ProcessesTelephone CoverageHIPAA ComplianceRemote Work PassionPayor CommunicationAppeal Letter Drafting

Helping families heal. We believe it. We live it. ______________________________________________ Full-time | M-F 9am - 5 pm | $18-20/hour | Benefits ______________________________________________ ...

February 26, 2026 View Details

RN Case Manager / Utilization Review

Greenlife Healthcare Staffing

Syracuse, New York, United States permanent
Patient CareEPIC SystemsUtilization ReviewDischarge PlanningInterdisciplinary CoordinationComplianceTechnical SkillsResource Utilization AnalysisED Case Management

RN Case Manager / Utilization Review - Syracuse, NY (#25268) • Location: Acute Care/Academic Medical Center, Syracuse, • Employment Type: Full-time • Hourly Rate: $65/hour About Greenlife Healthcare...

February 4, 2026 View Details
California (Chino) permanent
Strategic OversightTeam LeadershipRegulatory ComplianceOperational EfficiencyClaims ManagementInsurance LiaisonAudit CoordinationRegulatoryUpdatesPerformance MetricsProcess Improvement

Akido builds AI-powered doctors. Akido is the first AI-native care provider, combining cutting-edge technology with a nationwide medical network to address America’s physician shortage and make except...

February 26, 2026 View Details
Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California; Santa Cruz County, California (Mariposa, Merced, Monterey, San Benito, Santa Cruz) Hybrid permanent
Clinical LeadershipRegulatory AwarenessClinical JudgmentExecutive-Level RelationshipsStrategic ThinkingChange ManagementCross-Functional CollaborationCommunication SkillsTeam MentoringProcess Improvement

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That’s why we do not use AI or automated systems to review applications. Every application is re...

February 25, 2026 View Details
Bengaluru, KA, India permanent
Revenue OwnershipPartnership DevelopmentCommercial ProfilingCommercial DisciplineRevenue TargetCommercial AgreementsPipeline ManagementPublic Pricing StrategyEcosystem AlignmentRecurring Revenue Growth

About Bosch Mobility Platforms (MPS)  Bosch Mobility Platforms (www.bosch-mps.com) is shaping the future of connected mobility and logistics. As a cloud-native, platform-driven business within B...

February 24, 2026 View Details
Not specified contract
ReferralsEpic_Tapestry_UM_CertificationTapestry_Care_LinkPrior_AuthorizationsRouting_RulesWork_QueuesDecision_TreesNotification_LogicsTapestry_Care_Link_ConfigurationBenefit_Plan_ConfigurationProvider_Network_TieringClaims_Adjudication

Epic Tapestry Utilization Management Analyst (REMOTE) We are looking to hire a candidate with the skills sets mentioned and experience for one of our clients within the healthcare/health insurance do...

February 24, 2026 View Details
Bengaluru, KA, India permanent
Revenue OwnershipPartnership DevelopmentCommercial ScalingCommercial DisciplineInfrastructure Technology SalesParking OperationsPartnership BuildingMobility PlatformsAsset Monetization

About Bosch Mobility Platforms (MPS)  Bosch Mobility Platforms (www.bosch-mps.com) is shaping the future of connected mobility and logistics. As a cloud-native, platform-driven business within B...

February 20, 2026 View Details
Annapolis, MD permanent
Patient CareEMR SystemsHIPAAChart ReviewDenial ManagementCare CoordinationProcess Improvement

Position Objective: Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delay...

February 20, 2026 View Details
Santa Rosa, California, United States permanent
Patient CareMedical TerminologyEMR SystemsHIPAAAdmissionsRecordkeepingMedical NecessityCollaborationConcurrent Stay ReviewsPayment Appeals

ABOUT US: Formerly Aurora Santa Rosa Hospital, SRBHH was opened in 2016 and is regarded as an integral part of the greater Santa Rosa and Northern California mental health system of care. Convenientl...

January 30, 2026 View Details
US - Remote (Workday) Remote permanent
Utilization ManagementVendor ManagementProcess OptimizationCross-functional CollaborationSLA MonitoringPrior AuthorizationQuality Policy ComplianceEscalation ManagementStakeholder CommunicationAudit Support

About this role The Specialist, Utilization Management provides operational support and subject matter expertise to ensure the effectiveness and continuous improvement of Accolade's Utilization Manag...

February 12, 2026 View Details
Remote Remote permanent
Medicare CompliancePrior AuthorizationPharmacist LeadershipStaff ForecastingContract ManagementRegulatory ReportingTeam ManagementPolicy DevelopmentProcess OptimizationClinical Pharmacy

About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: • Capital Rx, a public benefit corpor...

February 10, 2026 View Details
Omaha, Nebraska Hybrid permanent
Microsoft Office SuiteData EntryMedical DocumentationCommunicationComplianceCustomer Service

WHAT WE'RE LOOKING FOR The Utilization Review Assistant ensures the timely and accurate collection of data and documents necessary for the utilization review process as well as independent medical rev...

December 12, 2025 View Details

Utilization RN

Confidential

Republic, Washington permanent
Patient CareEMR SystemsHIPAADischarge PlanningDocumentationClinical GuidelinesResource ManagementCommunicationAuditRegulatory Compliance

This is a union position. Open until filled. JOB SUMMARY The Utilization Review Nurse reviews medical records and treatment plans to ensure patients receive appropriate, necessary, and cost-effect...

February 9, 2026 View Details
Philippines Remote permanent
Customer ServiceMedical TerminologyHIPAAEMR SystemsInsurance GuidelinesDocumentationPreauthorizationSingle Case AgreementsAuthorization MechanismsClinical Partnership

The Utilization Review Specialist is responsible for managing all aspects of the utilization review process, including preauthorization, Single Case Agreements (SCA), continued authorizations, and col...

October 22, 2025 View Details
Chicago, IL, United States Remote permanent
Medical Records ReviewUtilization ManagementMedical Necessity DeterminationDecision CriteriaConsultation SkillsRegulatory ComplianceMental Health ParityPrior AuthorizationClinical Language

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

January 16, 2026 View Details
Decatur, IL, United States Remote permanent
Utilization ReviewClinical DeterminationsDecision CriteriaDocumentationCommunicationCollaborationCare CoordinationMember ComplaintsComplianceQuality Management

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

February 5, 2026 View Details
Peoria, IL, United States Remote permanent
Clinical Care ManagementUtilization ReviewBold Decision MakingRegulatory CompliancePatient CoordinationCare ManagementDocumentationCommunicationComplianceProfessional Development

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

February 5, 2026 View Details
Springfield, IL, United States Remote permanent
Utilization ReviewClinical DeterminationsDocumentationCommunicationCollaborationCare CoordinationMember ComplaintsComplianceQuality ManagementProfessional Development

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

February 3, 2026 View Details
Rockford, IL, United States Remote permanent
CommunicationCare ManagementCase ManagementDocumentationTrainingProcess ImprovementReportingKnowledge ManagementComplianceProfessional Development

WHO IS GUIDEHEALTH?  Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the h...

February 5, 2026 View Details