Utilization Manager Remote Jobs

Champion the Utilization Management program by leading a team to ensure high-quality service and adherence to clinical guidelines. Collaborate across functions to drive performance, facilitate continu...

Transform healthcare delivery by ensuring quality, compliant care for PACE participants. Collaborate with interdisciplinary teams to optimize service utilization and enhance outcomes, leveraging clini...

Champion operational excellence by leading Utilization Management programs, focusing on prior authorizations, inpatient reviews, and post-care management while collaborating with multidisciplinary tea...

Oversee a dynamic healthcare utilization management team, ensuring quality care through effective supervision of clinical reviews. Collaborate on initiatives to enhance processes and support team deve...

Empower healthcare delivery by utilizing clinical expertise for utilization management. You'll analyze requests, determine medical necessity, and facilitate communication across departments, ensuring...

Champion coordinated care by leveraging clinical nursing expertise to facilitate medical service determinations, ensuring optimal post-acute support for members. Collaborate with providers for effecti...

Advance the effectiveness of our utilization management team, ensuring compliance with best practices, improving member experiences, and managing daily operations to achieve optimal outcomes and cost...

Empower patient care by driving efficient authorization processes, leveraging strong clinical knowledge and advocacy to navigate insurance complexities while supporting a collaborative team dedicated...

Engage with us to transform patient care by utilizing your RN expertise in a non-clinical setting. You will review authorization requests, coordinate care, and collaborate with health professionals to...

Join a team that's redefining healthcare solutions by supporting member needs through expert utilization management. Leverage your clinical skills to ensure timely authorization and effective resource...

Lead the charge in coordinating healthcare delivery by collaborating with diverse professionals to optimize member care, assess health plan benefits, and ensure quality, cost-effective outcomes throug...

Join a dynamic healthcare team focusing on member care coordination, promoting effective utilization of services, and ensuring quality outcomes through collaboration with diverse professionals in a pa...

Oversee Utilization Management operations, ensuring compliance with contractual metrics, standards, and staff performance. Support team coordination and act as a key leader in healthcare program effic...

Elevate your career by supervising Utilization Management operations and ensuring compliance with clinical standards. Lead a team, drive performance, and collaborate across departments to enhance serv...

Champion the daily operations of utilization management by overseeing clinical staff, driving quality reviews, and optimizing workflow to enhance member care and achieve compliance with regulations in...

Grow your career with a dynamic role driving medical management programs, optimizing utilization processes, and ensuring compliance while leading data-driven strategies to improve outcomes across dive...

Manage claims operations and team performance to ensure compliance and efficiency. Oversee claims processing, data integrity, and reporting, while driving improvements through analysis and cross-funct...

Analyze and optimize the quality of patient care through clinical reviews, ensuring effective utilization of resources while adhering to established guidelines and policies...

Innovate in product strategy by defining value propositions, aligning stakeholders, and overseeing execution. Engage in sprint reviews to optimize performance and drive value across product portfolios...

Champion impactful partnerships by driving engagement and success with health system/provider networks. Utilize clinical research knowledge to foster collaboration among cross-functional teams and enh...

Join a team that empowers providers and members to enhance health outcomes through effective clinical review processes and collaboration, ensuring optimal care and cost efficiency across healthcare se...

Help us elevate healthcare by providing expert clinical support and guidance, ensuring optimal benefit determinations and quality care for our members while collaborating with a multidisciplinary team...

Deliver strategic leadership to enhance quality of care for UPMC Health Plan members. Oversee physician collaboration and adherence to health standards while driving comprehensive solutions for utiliz...

Lead the Utilization Management team in ensuring high-quality healthcare delivery. Oversee provider engagement and compliance with standards, fostering collaboration with physicians and hospitals to e...

Shape client payment policies by ensuring accuracy, delivering specialized requests, and collaborating effectively with internal and external teams to enhance service and compliance within healthcare...