Jobs

Physician Reviewer - Utilization Management

Oscar

New York, New York, United States (Remote (New York)) Remote permanent

Utilization ManagementClinical Decision MakingEvidence-Based GuidelinesDocumentationCommunicationComplianceState LicensurePhysician ReviewerTurn-Around TimesPeer-to-Peer Discussions

Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless ...

April 10, 2026 View Details

Senior Manager, Utilization Management & Claims

Akidolabs

Chino, CA (Chino) permanent

Strategic OversightTeam LeadershipRegulatory ComplianceOperational EfficiencyPerformance MetricsProcess ImprovementsPolicy MaintenanceRegulatory ReportingCost OversightRegulatory Timelines

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...

April 5, 2026 View Details

Manager, Utilization Management - Commercial

Capitalrx

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 Management Registered Nurse

Guidehealth

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

Utilization Management Registered Nurse

Guidehealth

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 Management Registered Nurse

Guidehealth

Archived 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

Utilization Management Registered Nurse

Guidehealth

Archived 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

Utilization Management Rep I

Mindlance2

Archived 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

Archived 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

Archived 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

Archived 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

Archived 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

Director, Utilization Management

Affirmedrxpbc

Archived 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

Utilization Management Technician Trainer

Capitalrx

Archived 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 Management Registered Nurse

Guidehealth

Archived 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

Utilization Management Registered Nurse

Guidehealth

Archived 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

Utilization Management Registered Nurse

Guidehealth

Archived 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

Utilization Management Registered Nurse

Guidehealth

Archived 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

Utilization Management Registered Nurse

Guidehealth

Archived 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

Utilization Management Registered Nurse

Guidehealth

Archived 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

Utilization Management Registered Nurse

Guidehealth

Archived 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

Utilization Management & Claims Senior Manager

Akidolabs

Archived 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

Utilization Management Director (RN)

Ccah

Archived 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

Epic Tapestry Utilization Management Analyst (REMOTE)

Confidential

Archived 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

Utilization Management Nurse

Luminishealth

Archived 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

Specialist, Utilization Management

Transcarent

Archived 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

Senior Manager, Medicare Utilization Management Pharmacist

Capitalrx

Archived 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

Contract Behavioral Health Utilization Management Medical Director (Psychiatry)

Guidehealth

Archived 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

Utilization Management RN Wanted!

HealthCareTalent

Archived Camarillo, CA, United States permanent

Patient CareClinical GuidelinesProblem-SolvingConflict ManagementOrganizational SkillsComputer LiteracyPatient AdvocacyRegulatory KnowledgeResource ManagementDocumentation

Are you a compassionate, detailed RN? We want the best Utilization Management Registered Nurse for our clients in Camarillo! Under the direction of the Manager, UM, this position will review requests...

March 30, 2016 View Details

Business Analyst- Care & Utilization Management

ComputerFutures3

Archived New York, NY, United States permanent

System AnalystsRequirements ElicitationDocumentationModelingStakeholder CommunicationProject Management

Computer Futures is a leading IT recruitment consultancy, specialising in placing IT experts in permanent and contract roles across Asia, Europe and the US. With a proven track record in IT recruitm...

August 9, 2016 View Details

Utilization Management Representative

PartneredStaffing-KellyServices

Archived Indianapolis, IN, United States permanent

Call CenterMedical terminologyCustomer Service

At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their bu...

September 22, 2016 View Details

Utilization Management Representative

PartneredStaffing-KellyServices

Archived Atlanta, GA, United States contract

Customer ServiceAnalytical SkillsCommunication SkillsMedical TerminologyInsurance KnowledgeEmployee ReferralsPension EligibilityPrior AuthorizationEMR Systems

Kelly Services in partnership with Nissan is currently seeking high skilled individuals to fill Production Technician openings at the Nissan manufacturing plant located in Canton, MS. Primary duties ...

December 30, 2016 View Details

Utilization Management Representative

PartneredStaffing-KellyServices

Archived Albany, NY, United States permanent

Customer ServiceCall HandlingPrecertificationPrior AuthorizationContinuous ScreeningReserve VerificationCustomer RelationsPC Proficiency

Kelly Services MAJOR DUTIES AND RESPONSIBILITIES • Responsible for coordinating cases for precertification and prior authorization review. • Manages incoming calls, including triage, opening of cases...

April 11, 2017 View Details

Utilization Management Rep

PartneredStaffing-KellyServices

Archived Thousand Oaks, CA, United States permanent

Medical TerminologyInsuranceCall Center ExperienceAnalytical SkillsCommunication SkillsComputer ProficiencyTime ManagementOrganizationDetail-Oriented

Kelly Services is looking to hire several Site Logistics Operators/Material Handlers in Knoxville, TN for an industry leading chemical company. For this opportunity, you could be placed as a Chemical ...

July 12, 2017 View Details

Utilization Management CoordinatorNE

UniversityOfMarylandMedicalSystem

Archived Glen Burnie, Maryland, United States permanent

Registered NurseClinical Usage FeedbackRegulatory ComplianceReimbursementDelivery Team CollaborationEmergency CareAcute CareMedical-Surgical CareCritical CarePsychiatric Patient Care

Experience the highest level of appreciation at UM Baltimore Washington Medical Center — named Top Workplace in the Baltimore area by The Baltimore Sun two years in a row (2019 & 2020); Top Workplace ...

December 18, 2025 View Details

Utilization Management Rep I

Mindlance2

Archived Albany, NY, United States contract

Customer ServiceCommunicationAnalytical SkillsMedical TerminologyPrior AuthorizationClaims ProcessingReferral ManagementProblem SolvingCustomer RelationsTime 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 Job Title : Utilization Manageme...

January 11, 2017 View Details

Utilization Management Specialist

IntegratedResourcesINC

Archived Miami, FL, United States contract

Clinical AnalyticsEvidence-Based Decision MakingUtilization ManagementHealthcare SectorMedical Necessity CriteriaRetail CoverageTelecommunicationsTime ManagementWard RoundsCredentialing

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...

April 4, 2017 View Details

Utilization Management Nurse Consultant

IntegratedResourcesINC

Archived Downers Grove, IL, United States contract

Clinical CareEMR SystemsHIPAAPatient CareUtilization ManagementDevelop StrategiesMalpractice CoverageCommunication

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...

May 5, 2017 View Details

Utilization Management Clinical Consultant

IntegratedResourcesINC

Archived Downers Grove, IL, United States permanent

Clinical SkillsUtilization ManagementCritical ThinkingEvidence-Based CareMedical Necessity CriteriaTotal Equipment EffectivenessHealthcare ServicesBenefit AdministrationManager EffectivenessClinical Practice Promotion

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...

May 8, 2017 View Details

Utilization Management Nurse

IntegratedResourcesINC

Archived Downers Grove, IL, United States contract

NursingClinical SkillsPatient CareBenefit AdministrationDevelop StrategiesCommunicationMultitaskingComputer ProficiencyHIPAA Compliance

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...

May 23, 2017 View Details

Utilization Management Professional

IntegratedResourcesINC

Archived Miami, FL, United States permanent

Clinical KnowledgeData AnalysisRegulatory ComplianceCommunication SkillsDischarge PlanningMedical DocumentationBenefit-EligibleCollaborationProblem SolvingDecision Making

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...

June 26, 2017 View Details

Utilization Management Professional,

IntegratedResourcesINC

Archived Miami, FL, United States permanent

Medical TerminologyHIPAAEMR SystemsUtilization ManagementProtocol ReviewRetail CoverageMedical Necessity CriteriaDischarge PlanningFollow-ups

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...

July 13, 2017 View Details

Senior Utilization Management Nurse

IntegratedResourcesINC

Archived Denver, CO, United States permanent

ClinicalUtilization ManagementBSNMedical History ReviewInterQualMCGManaged Care

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...

August 15, 2017 View Details

Utilization Management Professional

IntegratedResourcesINC

Archived Brooklyn, NY, United States contract

Clinical AnalyticsDrug Utilization ReviewsEvidence-Based Care PlansDischarge PlanningPatient AdvocacyMedical DocumentationCare CoordinationExecutive NegotiationMedication ManagementCustomer Transition

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 21, 2017 View Details

Utilization Management Tech

IntegratedResourcesINC

Archived Harrisburg, PA, United States contract

Customer ServiceCommunicationDocumentationHIPAA ComplianceCall Center ExperienceAuthorization SystemsClerical TasksDatabase ManagementQuality ReviewsProblem-Solving

Position Summary: The Utilization Management Tech functions under the direction of the Supervisor to coordinate, generate and track both incoming and outgoing correspondence, faxes and authorizations...

August 28, 2017 View Details

Physician Advisor, Utilization Management

Smarterdxprivate

Archived Remote (United States) (HQ) Remote permanent

Physician backgroundUtilization ManagementClinical reasoningLevel-of-care decisionsCMS SystemsAWS EMRAI Tool MasteryClinical gray areasPeer-reviewed PublicationsPayer

Physician Advisor, Utilization Management Role The Physician Advisor, Utilization Management (UM) Specialist will play a critical role in SmarterDx’s expansion into the Utilization Management space....

January 29, 2026 View Details

Utilization Management LVN

Welbehealth

Archived Los Angeles, CA, USA (Los Angeles Area, CA) permanent

Chart of AccountsAuthorization SystemsClinical InboxesInconsistency IdentificationLVN Licensure

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, while functioning as both a care provider and c...

February 3, 2026 View Details

Utilization Management Nurse - Emergency Department

Luminishealth

Archived Annapolis, MD permanent

Patient CareEMR SystemsHIPAAPhlebotomyVital SignsMedical TerminologyCPRBLS Certification

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

February 3, 2026 View Details

Utilization Management & Claims Coordinator

Akidolabs

Archived Chino, California (Chino) permanent

Clinical ExperienceUtilization ManagementClaims ProcessingReferral CoordinationQuality ReviewWorkflow ManagementRegulatory ComplianceTraining and Support

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 2, 2026 View Details

Utilization Management Assistant

Cottinghambutlerinsuranceservicesinc

Archived Dubuque, Iowa, United States (Dubuque, IA) Remote permanent

CommunicationCustomer ServiceDetail OrientedMedical TerminologyEMR SystemsHIPAAPatient Care

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...

January 28, 2026 View Details

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