Utilization Management Jobs

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.

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.

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.

Cleveland Clinic Tradition Hospital is hiring a Manager of Care Management to oversee utilization review, discharge planning, and a multidisciplinary care management team to improve patient outcomes and transitions of care.

Serve as the clinical and referral advocate for Emory’s rehabilitation services by assessing patients, coordinating admissions, and cultivating referral relationships to grow and streamline post-acute care access.

Northwestern Medicine is hiring an on-site Utilization Reviewer for Behavioral Health Services to manage precertification, continued stay reviews, discharge planning communication, and insurer appeals.

Northwestern Medicine is hiring an LSW to provide inpatient neurology social work services including psychosocial assessment, discharge planning, and crisis intervention.

Humata Health is hiring an RN with utilization management experience to help digitize payer policies, validate AI-driven prior authorization workflows, and coordinate cross-functional projects.

Sanford Health is hiring an RN Case Manager to lead inpatient care coordination and discharge planning for patients at its Sioux Falls facility.

Oscar Health is hiring a Growth Operations Analyst, Sales Oversight to own sales operations workflows, drive process improvements, and support training in a hybrid Tempe, AZ role.

Conifer Health is hiring a remote Personal Health Nurse (RN) to manage clinical assessments, individualized care plans, and care coordination for assigned clients while supporting value-based outcomes.

A Clinical Liaison role at Lehigh Valley Health Network responsible for referral screening, insurance verification/authorization, bed management and coordination of admissions for the inpatient rehabilitation facility.

Saint Mary’s Health Network is hiring an LPN Discharge Planner II to support case management and coordinate patient-focused discharge plans in an inpatient hospital setting.

UM Rehab & Ortho Institute is hiring an experienced RN Case Manager in Baltimore to lead utilization management, discharge planning, and interdisciplinary care coordination for inpatient rehabilitation patients.

CVS Health is hiring a remote Utilization Management Nurse Consultant (Behavioral Health) to conduct clinical reviews, manage prior authorizations, and apply evidence-based criteria for behavioral health and substance abuse services.

Experienced utilization review professional needed to manage authorizations, appeals, audit tracking, and serve as an SME for the UR team at Saint Mary of Nazareth in Chicago.

Personify Health is hiring an RN Case Manager to deliver telephonic case management, coordinate care plans, and support members with complex or chronic conditions.

Lead cross-functional design and implementation of enterprise quality programs (STARS, HEDIS, CAHPS) to improve member outcomes and quality ratings at a large national health services organization.

Lead interdisciplinary care planning and coordination for complex members in the Belen/Socorro region with Presbyterian Healthcare Services, a statewide nonprofit health system.

UMMC seeks an experienced RN Care Coordinator to deliver pediatric forensic care coordination, patient education, and evidence-based chronic disease management for children and families.

Presbyterian Healthcare Services is hiring a Care Coordinator II to manage care plans, perform assessments and coordinate interdisciplinary resources for members in the Albuquerque/Las Cruces region.

Experienced licensed psychologist needed to perform medical necessity reviews, appeals, and peer-to-peer consultations for Telligen’s managed care contracts on a part-time 1099 basis.

Sutter Health is hiring a Physician Advisor to lead utilization review, support clinical documentation improvement, and guide level-of-care decisions at its Sacramento facility.

Humana seeks a licensed Texas DDS/DMD with clinical and utilization review experience to serve as Dental Director, providing clinical oversight of claims, appeals, policy development, and quality initiatives for its Texas member population.

Coalfire seeks a Resource Deployment Manager to manage staffing requests, optimize utilization and capacity, and align technical talent to projects across professional services in a fast-paced, remote-friendly environment.

Paradise Valley Hospital seeks an on-site Discharge Planner for its behavioral health CSU to coordinate discharge plans, handle case management referrals, and manage Medicaid documentation on the night shift.

Experienced clinical social worker needed to provide assessments, crisis intervention, treatment planning and discharge coordination for inpatient behavioral health patients at Shasta Regional Medical Center.

Prime Healthcare seeks an organized Utilization Review Tech II to coordinate utilization review and appeals processes, manage payer communications, and maintain audit and denial tracking for our Ontario corporate/facility teams.

RightwayRx is hiring a Pharmacy Technician (CPhT) to perform utilization management tasks, process authorizations, and support specialty pharmacy coordination in their Dallas operations.

Lead strategic space planning and optimization for the University of Rochester's campus to ensure efficient allocation and data-driven management across academic, research, and clinical facilities.

Lead and scale North American workplace operations for Cloudflare by managing regional sites, vendor relationships, budgets, and a growing team to deliver a safe, efficient, and welcoming workplace experience.

Clinical Pharmacist (Utilization Management) to support PBM clinical operations by reviewing utilization requests, creating policy, and coordinating with prescribers and internal teams to drive safe, cost-effective medication access.

Centene seeks a board-certified MD/DO to serve as a Remote Medical Director for Georgia, providing clinical leadership for utilization management, quality improvement, and credentialing.

Mass General Brigham seeks an RN Supervisor, Utilization Management to lead and coach a clinical team conducting inpatient and outpatient utilization reviews while driving quality, productivity, and system improvements.

Experienced LVN/RN with utilization review background needed to perform clinical reviews, determine medical necessity, and collaborate with providers and case teams in a remote Utilization Management Nurse Reviewer role at Dane Street.

Lead and grow ARH's regional Utilization Review program by directing staff, ensuring compliance with regulatory standards, and optimizing patient care and resource utilization.

Rightway is hiring a PBM Benefits Coordinator to manage benefit plan configuration, formulary maintenance, and related operations for its PBM offerings.

CareSource seeks an experienced Community Based Care Manager to coordinate person-centered care across community, facility, and home settings for Medicaid members.

Experienced care management leader needed to oversee utilization review, case management operations and cross-functional partnerships at Children’s Mercy, advancing clinical outcomes and operational efficiency.

Experienced, board-certified physician needed to lead Utilization Management strategy and clinical operations at Wellmark, driving evidence-based UM decisions, team development, and cross-functional initiatives to reduce overuse and improve quality.

USC seeks an onsite Discharge Planning Coordinator to support case managers with discharge planning, post-acute coordination, and patient follow-up in an ambulatory/value-based care setting.