Utilization Management Jobs

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Senior Manager, Professional Services Operations to lead forecasting, process optimization, and operational programs that improve utilization, governance, and revenue delivery for Okta’s Customer First services organization.

Lead Humana's Illinois behavioral health clinical program as Chief Psychiatrist, integrating clinical oversight, quality and utilization management, PBM coordination, and Medicaid BH product development.

CenterWell Home Health (a Humana company) is hiring a Clinical Manager to oversee clinical staff, patient care delivery, and quality operations for its Birmingham home health location.

HealthAxis is hiring a part-time Medical Director (Utilization Management) in Tampa to lead clinical review, medical necessity determinations, and UM program improvements for payer clients.

Experienced Utilization Review Specialist needed to manage authorizations, negotiate SCAs, and handle continued stay reviews for a remote behavioral health team serving adolescents.

HealthAxis seeks a Utilization Management Intake Coordinator to handle authorization intake, verify eligibility, and route requests accurately to support timely member and provider service.

HealthAxis is hiring a Medical Director of Utilization Management to lead clinical review decisions, ensure regulatory-compliant UM programs, and drive process improvements across payer-facing operations.

Saint Luke's East Hospital is hiring a licensed RN or LMSW to supervise care progression, lead case management activities, and drive timely patient discharges across inpatient units.

Carelon Medical Benefits Management, an Elevance Health company, is hiring a board-certified MD/DO as an Associate Medical Director to provide timely clinical case reviews and medical necessity determinations in radiology and utilization management.

Experienced UM Pharmacist needed to lead policy translation and clinical validation for an AI-driven prior authorization platform at Innovaccer.

Join VSHP as a Remote Clinical Assistant supporting Utilization Management by managing prior authorizations, member and provider inquiries, and claims-related tasks.

Memorial Healthcare System is hiring an RN Case Manager to manage utilization review and discharge planning for ED and entry-point patients at Memorial Regional Hospital South.

Senior Case Manager at UMMC Midtown Campus responsible for care coordination, discharge planning, utilization management and multidisciplinary leadership to improve patient outcomes and reduce avoidable days.

Lead the Care Management department at Wiregrass Ranch Hospital to oversee utilization management, discharge planning, care coordination and quality improvement initiatives across the patient care continuum.

West Anaheim Medical Center is hiring a Case Manager to manage utilization review, coordinate discharge planning, and ensure quality, clinically appropriate, and cost-effective patient outcomes.

Lead Centinela's Case Management and Utilization Management team to improve care coordination, reduce readmissions, and ensure efficient, patient-centered transitions of care.

Experienced board-certified psychiatrist sought to serve as a part-time Behavioral Health Medical Director for New Jersey Medicaid, providing clinical leadership, utilization review oversight, and provider consultation in a hybrid/virtual capacity.

Experienced licensed psychologist needed to conduct clinical authorization and peer review for behavioral health services on Centene's remote Medical Management team (must be licensed and reside in Florida).

Lead Centene's behavioral health utilization management team in a remote Florida-based Senior Director role focused on clinical quality, policy, operations, and cross-functional leadership.

Provide care coordination and case management for WRAP-eligible patients across the ED, community, and remote settings to reduce admissions and improve patient-centered outcomes.

Lead inpatient care transitions as a Transition Nurse Navigator at University of Maryland Upper Chesapeake Health, coordinating plans and resources for high-risk patients to ensure safe, efficient discharges.

A board-certified physician with DRG audit expertise is sought to deliver rigorous clinical reviews and directly inform the development of Machinify's AI-powered DRG adjudication platform.

Humata Health is hiring an Intake Solutions Specialist to manage and process prior authorization requests accurately and efficiently in a remote or hybrid role supporting medical and pharmacy workflows.

CenterWell (Humana) seeks a remote Utilization Management Administrative Coordinator to manage provider phone intake, process referral authorizations, and support efficient UM operations.

Northwestern Medicine is hiring a full-time RN Case Manager for its Neuro Rehab Clinic to lead discharge planning, utilization management, and care coordination for complex patients on day shifts.

Rising Medical Solutions is hiring a Referral Coordinator to coordinate services, manage case files, and facilitate communications between patients, providers, employers, and nurse case managers.

Humata Health is hiring a Provider Strategy Lead to drive provider engagement and operational alignment for AI-enabled prior authorization across national payer customers.

Highmark Inc. is hiring a remote Care Management Coordinator in Pennsylvania to handle pre-certification requests, route cases to clinical reviewers, and ensure compliance with regulatory and company standards.

NewYork-Presbyterian Queens seeks an experienced RN Case Manager to lead inpatient care coordination and discharge planning for complex adult patients on the day shift.

Humana is seeking a licensed behavioral health clinician to perform utilization management reviews, coordinate care, and communicate treatment plans for members across Kentucky in a full-time remote role.

Select Specialty Hospitals in Pensacola is hiring a PRN Case Manager (RN/RT/LPN/SW) to manage utilization reviews, discharge planning and care coordination for chronically and critically ill patients.

Lead operational strategy and execution to scale value-based care programs, optimize provider performance, and reduce total cost of care at Pearl Health.

St. Luke's University Health Network is hiring an Inpatient Social Worker Care Manager to lead discharge planning and provide psychosocial support for hospitalized patients at the Warren Campus.

Lead and manage clinical operations for CenterWell Home Health in Grand Junction, overseeing clinicians, care plans, compliance, and quality improvement to ensure excellent patient-centered home care.

Northwestern Medicine is hiring a part-time Clinical Admission Nurse for nights to manage admissions, apply clinical criteria, and coordinate patient flow and insurance considerations.

Northwestern Medicine is hiring a part-time RN Care Coordinator at Kish Hospital in DeKalb, IL to lead utilization management, discharge planning, and payer communication for acute care patients.

Experienced RN with utilization review or direct clinical care background needed to assess medical necessity and coordinate Workers’ Compensation treatment and pharmacy authorizations for AmTrust.

St. Luke's is hiring a part-time Inpatient RN or MSW Care Manager to lead discharge planning, psychosocial assessment, and care coordination for hospitalized patients across the continuum of care.

Provide efficient phone intake and administrative support for utilization management inquiries, ensuring accurate authorizations and excellent provider service for a Humana-affiliated senior care organization.

Provide clinical case management and utilization review for critically ill and post-ICU patients at Select Specialty Hospital, using your licensed clinical background and critical care experience to coordinate safe, timely discharges and optimal reimbursement.

Cooley is hiring an experienced Associate Director of Associate Development to lead ADM operations for the Corporate practice and advance associate performance, staffing, and talent initiatives.

Highmark is hiring an Associate Intake Coordinator to handle prior authorization outbound calls and create triage cases while ensuring accurate documentation and regulatory compliance.

Lead Brellium’s behavioral health clinical quality efforts by building and scaling QA programs, translating AI insights into actionable improvements, and partnering with customers and product teams to elevate documentation, compliance, and care quality.

Experienced utilization-review and case-management professional needed to oversee precertification, concurrent review, appeals, and discharge planning at a Greenwood behavioral health hospital.

Select Specialty Hospitals seeks a PRN Case Manager (RN/RT/LPN/MSW) with critical care experience to perform utilization review, discharge planning and care coordination for post-ICU patients.

St. Luke’s Health System is hiring a Part-Time RN Case Manager to provide clinical assessments, care coordination, and discharge planning for patients at Nampa and Meridian hospitals.

UM Capital Region Medical Center is hiring a licensed MSW to deliver weekend clinical and case management services focused on assessment, discharge coordination, and benefits support.

The Ohio State University Health Plan is hiring a Registered Nurse Patient Care Resource Manager to perform retrospective claims reviews, support utilization management, and contribute to clinical policy and process improvements for its member population.

Lead utilization review and discharge planning as an RN Case Manager at a premier academic medical center in Syracuse, ensuring EPIC-compliant documentation and efficient post-acute transitions.

St. Luke's University Health Network seeks a Crisis Intervention Specialist I to perform psychiatric intake assessments, coordinate appropriate referrals and placements, and support behavioral health response in the Emergency Department and Walk-In Center.