Utilization Jobs

ServiceNow seeks a Senior Sales Operations Manager to lead capacity planning and resource allocation for Product Excellence, ensuring resources are optimally aligned to strategic priorities across GenAI, CRM and cross-functional teams.

MGA Homecare seeks an organized, client-focused Client Services Manager in Nashville to manage non-clinical client relationships, staffing logistics, and service utilization to improve satisfaction and retention.

Atrium Health Union is hiring an RN Care Manager (PRN days) to provide case management, care coordination, and documentation for patients across multiple care settings.

Lead and coach a team of clinical pharmacists to design and operationalize evidence-based pharmacy programs that improve outcomes and control pharmaceutical spending for Wellmark members.

Dane Street is hiring Board-Certified Forensic Pathologists to perform remote disability peer reviews as independent contractor physician advisors, providing expert, evidence-based case assessments on a flexible, per-case schedule.

Provide clinical chart review and utilization management support at Saint Mary’s Regional Medical Center, ensuring appropriate criteria for admission and continued treatment while coordinating with clinical teams and payers.

OhioHealth seeks an experienced RN Care Manager to coordinate patient-centered care, apply evidence-based interventions, and collaborate across the care continuum at Riverside Methodist Hospital.

Peraton's SafeGuard Services seeks a seasoned Medical Review Manager (RN) to lead and develop a nursing medical-review team focused on detecting and referring Medicare and Medicaid fraud, waste, and abuse.

Provide remote, per-case independent medical necessity reviews in Radiation Oncology for a national IRO, working as a flexible 1099 contractor with a caseload you control.

Provide clinical and operational leadership for Rapid Response, Care Escalation, and Code Blue services at OHSU, driving quality improvement and staff readiness across the hospital.

Registered Nurse specializing in Utilization Management sought for onsite role at Vandenberg Space Force Base to conduct utilization reviews, coordinate interdisciplinary care, and support documentation and appeals.

Dane Street seeks Board Certified Pulmonary physicians with an active Washington license to perform telework medical necessity reviews as independent contractors on a flexible, per-case basis.

UChicago Medicine Ingalls Memorial is hiring a part-time Utilization Management Case Manager (Newborn) to manage utilization review, discharge planning, and care coordination for neonatal patients during daytime hours.

Provide objective, evidence-based utilization reviews for Dane Street as a remote, board-certified dental specialist with an active New York license.

Northwestern Medicine is hiring a full-time Nurse Case Manager in Winfield, IL to coordinate patient care, support seamless transitions, and optimize clinical and cost outcomes.

HGA is hiring a Sr Medical Planner in Minneapolis to lead healthcare programming and spatial planning for complex hospital and clinical projects.

Experienced clinical professional needed to serve as the field link between acute and post-acute providers, improving SNF performance, care transitions, and value-based outcomes across a multi-state region.

Lead the commercialization and operational execution of professional services at a fast-growing SaaS company by building pricing/packaging, governance, and sales enablement to improve attach rates and margins.

SIXT is hiring a Revenue Management Analyst to support pricing, competitor monitoring, and revenue optimization across U.S. markets in a hybrid work format.

Emory Healthcare is hiring a Resource Utilization Nurse (RUN) in Decatur to provide critical-care transport, code response, and interim ICU coverage to support continuity and quality of care.

Lead product strategy and execution for oncology prior authorization solutions to improve patient access and streamline provider and payer workflows at Innovaccer.

Support clinical review workflows at Telligen by coordinating medical information, communicating review decisions, and ensuring data integrity in a hybrid in-office role.

Highmark is hiring a Remote Medical Case Manager (PA-licensed) to coordinate care, develop individualized plans, and manage complex medical and psychosocial cases for Pennsylvania members.

ServiceNow is hiring a Resource Manager to drive capacity forecasting, staffing and partner governance that maximizes billable utilization across professional services.

CommonSpirit Health seeks an RN Case Manager at St. Anthony Hospital (Lakewood) to coordinate patient care, manage utilization, and support transitions from admission through discharge.

Provide advanced disease-management nursing and population health coordination for military beneficiaries at Nellis AFB, emphasizing prevention, chronic care support, and interdisciplinary collaboration.

Work as a clinically focused RN on Humata Health’s payer operations team to digitize policies and validate AI-driven prior authorization workflows.

CVS Health is hiring a California-licensed Senior Analyst, Health Care Quality Management to lead delegation oversight and regulatory compliance for delegated clinical partners.

UChicago Medicine Ingalls is hiring a full-time onsite Utilization Management Case Manager (RN) to lead utilization reviews, coordinate care across teams and payers, and support clinical and operational outcomes at its Harvey campus.

Experienced care coordination professional needed to lead interdisciplinary care planning and manage complex member cases across medical, behavioral and community services within Presbyterian Healthcare Services.

Dane Street seeks board-certified PM&R and Pain Management physicians to serve as independent contract reviewers providing telework disability review opinions.

Northwestern Medicine is hiring a Charge Nurse (RN) to lead clinical care and operations for the Oncology Infusion unit on full-time day shifts at the Oakbrook location.

Dane Street is recruiting board-certified Interventional and Diagnostic Radiologists to perform remote, per-case medical necessity reviews and appeal determinations on a flexible contract basis.

Experienced prescriber clinician wanted to develop and refine psychiatry-focused progress note templates and AI prompts for a remote-first mental health tools company.

Experienced RN with utilization management and prior authorization expertise needed to validate and improve AI-driven prior authorization workflows at Innovaccer.

Experienced clinical leader needed to direct case management and care coordination at an inpatient rehabilitation hospital partnered with Ochsner and Select Medical.

Provide inpatient rehabilitation case management (RN or LMSW) on a per-diem basis, coordinating care, discharge planning, and utilization management for complex rehab patients at Ochsner Rehabilitation Hospital.

Saint Clare's Health is hiring a licensed clinician (LPC/LCADC; LCSW preferred) to provide clinical services, crisis intervention, and treatment planning for youth in its Child/Adolescent PHP.

An experienced RN is sought for the Dialysis Care Coordinator role at UVM Medical Center to lead multidisciplinary dialysis care and coordinate services for a defined patient population.

Dane Street is hiring Board-Certified Plastic Surgeons licensed in Louisiana to perform flexible, remote utilization reviews on a contract basis, paid per case.

Lead the case management team at Select Specialty Hospital in Madison, directing utilization review, discharge planning, payer coordination, and staff development for medically complex patients.

Lead a remote Utilization Management team at CVS Health to ensure compliant, high-quality clinical interventions and strong operational performance for member care.

Dane Street is recruiting NY-licensed, Board-Certified Occupational Medicine physicians to perform flexible, remote utilization reviews and produce guideline-based decisions on a per-case contract basis.

Desert Valley Hospital is hiring an experienced RN Case Manager to oversee utilization management, discharge planning, and care coordination for admitted patients in a fast-paced acute-care environment.

Humana is hiring a Compliance (UM) Coordinator 2 to produce Medicaid UM determination notices, analyze compliance data, and maintain quality metrics in a remote role.

Centinela Hospital Medical Center is hiring an RN Case Manager to coordinate inpatient care, perform concurrent review for medical necessity, and support cost-effective, high-quality patient outcomes.

UM St. Joseph Medical Center is hiring an RN Care Manager to lead interdisciplinary care coordination and transition planning for acute-care patients while ensuring quality outcomes and efficient resource use.

Experienced RN/LPN with utilization review and healthcare operations experience needed to lead Dane Street's remote regional operations team, drive profitability, and ensure quality and scheduling performance.

Experienced nursing leader needed to oversee ambulatory care management programs, staff, and operations to advance value-based care and improve patient outcomes at USC Health Sciences Campus.

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