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Rockford, IL, United States Remote permanent
Clinical Care ManagementUtilization ReviewClinical DeterminationsMedical DocumentationRegulatory ComplianceQuality ManagementMedical Provider CoordinationBenefit AwarenessRegulations KnowledgeProfessional 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
Chicago, 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 6, 2026 View Details
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

Utilization Review (RN) - Per Diem

KittitasValleyHealthcare

Ellensburg, WA, United States permanent
Registered NurseClinical ExperienceEvidence-Based CareCMS SupportInsurance Pre-AuthorizationRevenue CycleLength of Stay AnalysisContinuing EducationEmployee Expenses Support

KVH is an integrated healthcare delivery system that includes 24-hour emergency care, inpatient, and outpatient hospital services through KVH Hospital. Clinics and services provided include family med...

February 5, 2026 View Details
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
Tallahassee, FL, United States permanent
Patient CareClinical AssessmentDischarge PlanningInterdisciplinary CollaborationMedication ReviewsHealth and UtilizationDistributed Systems OptimizationRegulatory CompliancePost-Acute TransitionPatient Education

• Hourly Rate: $31.94 – $43.92 (based on experience) • Shift Differentials: +$2.50/hr evenings, +$2.00/hr weekends (stackable up to +$4.50/hr) • Sign-On Bonus: $10,000 (paid in 5 installments over 2...

August 22, 2025 View Details

Utilization Management Representative

PartneredStaffing-KellyServices

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

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

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

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

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
Chicago, IL, United States permanent
Patient CareClinical ExpertiseStatus ReviewQuality ImprovementChange ManagementInterdisciplinary CollaborationEMR SystemsHIPAA CompliancePerformance ImprovementTeam Leadership

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...

January 21, 2026 View Details
Lake Forest, IL, United States permanent
Patient CareHIPAAEMR SystemsClinical SkillsEvidence-Based NutritionResource UtilizationMedical NecessityProvider RelationsDocumentationQuality Improvement

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...

January 29, 2026 View Details
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
Hanover, MD, United States permanent
Healthcare ManagementClinical SupervisionCase ManagementMember CoordinationService DeliveryProfit AnalysisCost ContainmentStaff RecruitmentPerformance EvaluationComputer Literacy

Hosp Rn Mgr Utilization Mgmt  Hanover, MD Exp 5-7 yrs Deg Bach Bonus Job Description   Responsible for providing clinical supervision to a team responsible for coordinating member service, uti...

April 14, 2015 View Details
Wilmington, DE, United States permanent
Patient CareUtilization ManagementEMR SystemsHIPAAQuality ImprovementData AnalysisCommunicationEthicsEducationRegulatory Compliance

Healthcare Embedded Clinical Care Coordinator - Utilization//Pediatrics/InterQual Please note: This will be an embedded position at a children's hospital in Wilmington, Delaware. General Overv...

August 12, 2016 View Details
Newark, NJ, United States permanent
Registered Nurse LicenseBLSCase ManagementDrug Utilization ReviewsMulti-taskingTime ManagementPrioritizationTeamworkCustomer FocusProject Management

A Few Words About Us 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 excellen...

March 9, 2015 View Details

Registered Nurse-Utilization Review

IntegratedResourcesINC

Trenton, NJ, United States contract
Patient CareEMR SystemsHIPAAClinical Decision MakingData AnalysisComputer LiteracyFast-Paced EnvironmentCommunication Skills

A Few Words About Us 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 excellen...

March 11, 2015 View Details

Utilization Review Nurse (RN)

IntegratedResourcesINC

Raleigh, NC, United States contract
Clinical Decision MakingAssessmentTeaching SkillsProblem SolvingLegal TerminologyEthical ConductUtilization ManagementQuality ManagementOutcome DefinitionMicrosoft Windows

A Few Words About Us - 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 excell...

June 26, 2015 View Details

Utilization Review Nurse

IntegratedResourcesINC

North Charleston, SC, United States permanent
Patient CareClinical AnalyticsBenefit AdministrationDischarge PlanningMedical Necessity CriteriaCase ManagementCommunicationDocumentationContinuous Improvement

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...

November 23, 2015 View Details

Utilization Management Specialist

IntegratedResourcesINC

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
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
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

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

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

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

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 Review RN

IntegratedResourcesINC

Watertown, NY, United States permanent
Registered NurseDrug Utilization ReviewsClinical InformationGroup InsuranceHealthcare Revenue CycleDischarge PlanningQuality ImprovementRisk ManagementPatient CareEMR Systems

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 17, 2017 View Details

Utilization Management Professional

IntegratedResourcesINC

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

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

FSM Utilization Specialist

prosidianconsulting

Washington, DC, United States contract
Financial ManagementChargeback MitigationMacroeconomic MonitoringComplianceDocumentationFee Structure ChangesRecommendationsIT BackgroundIT Application SupportEconomic Analysis

ProSidian is a Management and Operations Consulting Services Firm focusing on providing value to clients through tailored solutions based on industry leading practices.  ProSidian services focus on th...

July 12, 2019 View Details

FSM Utilization Specialist - CO

prosidianconsulting

Boulder, CO, United States contract
Financial ManagementChargeback MitigationMacroeconomic MonitoringComplianceLoan DocumentationFee ValidationService Recommendations

ProSidian is a Management and Operations Consulting Services Firm focusing on providing value to clients through tailored solutions based on industry leading practices.  ProSidian services focus on th...

July 24, 2019 View Details

FSM Utilization Specialist - WA

prosidianconsulting

Seattle, WA, United States contract
Financial ManagementChargeback MitigationMacroeconomic MonitoringComplianceLoan DocumentationFee Structure ChangesIT Background

ProSidian is a Management and Operations Consulting Services Firm focusing on providing value to clients through tailored solutions based on industry leading practices.  ProSidian services focus on th...

July 29, 2019 View Details
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
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
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
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

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

Utilization Management CNA

Cottinghambutlerinsuranceservicesinc

Dubuque, Iowa, United States (Dubuque, IA) Remote permanent
CommunicationCustomer ServiceDetail OrientedMedical TerminologyEMR SystemsHIPAA

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
Buckeye Lake, Ohio, United States permanent
Case ManagementUtilization ManagementCDIPatient CareQuality ImprovementData AnalysisFinancial ManagementRegulatory ComplianceLeadershipCollaboration

TITLE: Director Case Management / Utilization Management / CDI Location: Buckeye Lake, OH Now is your chance to join a Forbes magazine top 100 hospital where career growth and opportunity await you. ...

November 21, 2025 View Details
Makati, Metro Manila, Philippines permanent
Clinical Nurse ReviewerUtilization ManagementMDSPHRN LicenseDialysis TrainingClinical AppealsRevenue Cycle ManagementVerbal CommunicationWritten CommunicationNight Shift

ISTA Solutions, an outsourcing/offshoring company, is in search of a Utilization Reviewer to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly...

December 18, 2025 View Details
West Bloomfield, Michigan permanent
Clinical DocumentationInsurance AuthorizationClinical AuditsData TrackingCompliance ReportingCredentialingElectronic Health RecordZoomMicrosoft OfficeAttention to DetailCommunicationOrganization

River’s Bend is a growing Outpatient Mental Health and Substance Use therapy practice which provides the most innovative, evidence-based outpatient behavioral healthcare to all our clients and their f...

January 30, 2026 View Details
Greenville, Mississippi permanent
Patient CareCommunicationDischarge PlanningUtilization ReviewHIPAACPRBehavioral Management TrainingEthicsDocumentation

POSITION SUMMARY: The Case Manager, in accordance with the Joint Commission, Federal, and state regulations, Freedoms' mission, policies and procedures and PI standards, is responsible for coordinati...

January 30, 2026 View Details
Greenville, Mississippi permanent
CommunicationPatient CareDocumentationRegulationsCollaborationEthicsUtilization ReviewDischarge PlanningReferral CoordinationCPR

POSITION SUMMARY: The Case Manager, in accordance with the Joint Commission, Federal, and state regulations, Freedoms' mission, policies and procedures and PI standards, is responsible for coordinati...

January 30, 2026 View Details
Monroe, Louisiana permanent
Effective communicationOrganizational skillsInterpersonal skillsAnalytical problem solvingData analysisCompliance with regulationsPre-certification reviewClinical information reviewConsultation and referralTechnical proficiency (PC computers)

This position is currently filled. Thank you for your interest in this position. Our company is consistently recruiting for good staff. Please continue to apply for any future needs/growth. Freedom B...

January 30, 2026 View Details
Remote (Remote (Arizona)) Remote permanent
NursingUtilization ReviewMedical RecordsClinical JudgmentEvidence-Based GuidelinesDecision-Making SLAsCompliancePatient CareManaged Care

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

December 10, 2025 View Details
Remote (Remote (New York)) Remote permanent
Clinical ReviewEvidence-Based GuidelinesDocumentationCommunicationTurn-Around TimesPeer CollaborationComplianceLicensureUtilization ManagementHealthcare Industry

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 ...

December 8, 2025 View Details
Jefferson, North Carolina permanent
Patient CareUtilization ReviewRegulatory ComplianceCommunicationInterdisciplinary CoordinationReferral ManagementDischarge PlanningInpatient Utilization ReviewPreauthorizationComputer Literacy

At Ashe Memorial Hospital, we are driven by our Mission Statement, "To meet the needs of the community by delivering patient-centered, high quality health care."   Ashe Memorial Hospital is proud to...

January 30, 2026 View Details