Utilization Jobs

Senior Pharmacy Benefit Consultant needed to lead complex client relationships, vendor strategy and pharmacy benefit program design for PSG's hospital, health system and employer clients.

Wellmark seeks a Sr Business Support Consultant to lead UAT and serve as the Health Services SME for care management system initiatives, testing, configuration and stakeholder collaboration.

Lead Dane Street’s Group Health Division operations to improve client metrics, grow the business, and manage a team of Utilization Management nurses while owning divisional P&L.

Emory Healthcare is hiring a Value Analysis Service Line Manager to lead clinical value analysis, product/service introductions, and cost-reduction initiatives across Atlanta-area facilities.

Work remotely as a Medical Coder for a mission-driven team, applying ICD-10, CPT, HCPCS and PCS coding across settings while supporting QA, utilization review, and coding validation.

Wellmark seeks an experienced Client Solutions Consultant (or Senior Consultant) to analyze complex healthcare data and deliver strategic, consultative recommendations to large-group clients, brokers, and internal stakeholders.

Wellmark is looking for a detail-oriented Utilization Management Nurse to conduct prior authorizations, utilization reviews, and care coordination for members while supporting timely discharge planning and medical necessity determinations.

HealthHelp, part of WNS, is hiring a VP of Client Services to lead C-suite client relationships, drive revenue growth and profitability, and manage large-scale account implementations and reporting.

Experienced care coordination professional needed to lead interdisciplinary care plans and ensure cost-effective, high-quality outcomes for Presbyterian Healthcare Services members in Albuquerque.

Experienced nurses are sought to manage utilization reviews and prior authorizations remotely for Presbyterian Healthcare Services, ensuring clinical appropriateness, timely authorizations, and quality audit oversight for Albuquerque-area members.

Garden Grove Hospital Medical Center is hiring a Medical Review Coordinator to perform clinical record reviews and coordinate utilization review and case management to ensure appropriate, compliant patient care and documentation.

Alignment Health is seeking a detail-oriented Utilization Management (UM) Coordinator to support inpatient and pre-service operations at its California corporate office, focusing on census management, authorizations, and discharge coordination.

Experienced RN Case Manager needed to lead utilization management and care coordination at Chino Valley Medical Center, ensuring medical necessity, efficient resource use, and quality patient outcomes.

Prime Healthcare Hospice seeks an experienced Field Nurse Case Manager to manage hospice admissions, coordinate care across providers, and ensure clinically appropriate, cost-effective outcomes.

Experienced workers' compensation nurse case manager sought to manage field cases, coordinate care, and improve outcomes for injured workers at Rising Medical Solutions.

A US-based healthcare startup requires a Physician Medical Director to oversee medical operations and drive quality initiatives with extensive travel and flexible remote-hybrid work.

Support health services coordination at Presbyterian by managing prior authorizations, claims documentation, referrals, and provider/member communication in an onsite administrative role.

Provide clinical leadership and supervision for World Relief’s refugee and immigrant case management programs in Sacramento, ensuring high-quality, trauma-informed services and regulatory compliance.

Experienced RN Case Manager needed to oversee inpatient acute observation care coordination at Presbyterian Healthcare Services in Albuquerque.

Behavioral Health Clinical Case Manager role at CVS Health involves clinical case assessment, care coordination, and member support to enhance behavioral and physical health outcomes.

The Clinical Health Services Associate Manager will lead utilization management teams remotely for CVS Health, ensuring operational excellence and regulatory compliance.

CVS Health is hiring a remote Medical Director for Medical Affairs to lead clinical oversight and utilization management activities across the enterprise.

Utilization Review Specialist / RN at Emory Healthcare responsible for comprehensive patient care reviews ensuring appropriate utilization and compliance in a remote work setting.

Virtua Health is hiring a Per Diem Outcomes Manager with RN or MSW credentials to coordinate patient care across various South Jersey facilities.

Lead the planning and optimization of our nationwide linehaul network as a Director/Manager, driving scalable, cost-effective middle-mile transportation solutions.

Availity is seeking a strategic Senior Healthcare Executive to lead and grow complex payer accounts remotely, driving revenue through consultative sales of utilization management solutions.

Experienced RN Case Manager wanted at Geisinger to support patient care through the innovative Care Without Delay program in Wilkes-Barre, PA.

Empower patients as a Registered Nurse Case Manager at Intermountain Health, bridging hospital care and home health services with expert coordination and compassionate advocacy.

Berkeley Medical Center is looking for an experienced Case Manager Nurse to support patient care transitions and utilization management onsite.

An experienced MD/DO is needed to perform second-level utilization reviews ensuring effective and compliant patient care within Greenlife Healthcare Staffing's network.

Royal Oak Hospital is looking for an experienced RN Care Coordinator to enhance patient care and discharge planning within their esteemed academic health system.

Experienced RNs are sought by Telligen to lead utilization reviews and mentor clinical teams in a hybrid work environment.

Steer Transfr's Business Intelligence strategy as a Senior Manager, driving cohesive data insights that empower impactful decision-making across teams.

Contribute to innovative clinical pharmacy programs and formulary management as a Clinical Pharmacist with Wellmark Blue Cross Blue Shield.

Experienced Clinical Education Nurse needed at HealthHelp to lead training initiatives enhancing clinical care and utilization management processes.

Lead Sedgwick’s clinical operations remotely as a Clinical Director, managing multiple teams to deliver exceptional case management and utilization review services.

Lead contract negotiations and supply chain utilization initiatives at Ochsner Health, driving cost-effective solutions and product standardization.

Manage high-quality coordinated care for Elderplan/HomeFirst members as a Managed Care Coordinator II at MJHS, a respected nonprofit healthcare organization.

Lead health management program staff and ensure compliance and quality improvements at Telligen, a leading population health management company.

Experienced Registered Nurse needed to coordinate utilization management and quality oversight for nursing and PACE facilities at Telligen.

An experienced Registered Nurse is sought by Telligen to coordinate utilization reviews, handle eligibility appeals, and mentor peers within a population health management setting.

Telligen is seeking a Review Assistant II to support healthcare utilization review processes by managing case preparation, data accuracy, and stakeholder communication.

Support complex rehabilitation patients as a Case Manager at OhioHealth Neuro Transitional Center in Dublin, Ohio.

JLL seeks an Occupancy Planner to manage space planning and workplace strategy initiatives for their Houston office, blending real estate expertise with data analytics in a hybrid work setting.

Seeking Board-Certified General Surgeons for remote, independent medical review roles with flexible scheduling and supplemental income opportunities at Dane Street.

Seeking an experienced RN Case Manager to support patient care and resource management at Baptist Health Shelby Hospital's Geriatric Psychiatric unit in Alabaster, AL.

MultiCare is hiring a Care Coordinator Associate to support patient care transitions by working closely with physicians and clinical teams in Tacoma, Washington.

Evolent is seeking a licensed Nurse Reviewer to perform precertification and utilization review tasks remotely to support better healthcare outcomes.

Lead critical discharge planning and care coordination as an RN Case Manager at a nationally recognized healthcare institution.

Cottingham & Butler is seeking a Utilization Management CNA to evaluate certification requests and support healthcare utilization review from their Dubuque, IA location with remote options within Iowa.