20 Healthcare Utilization Specialist jobs

United States (Remote)

$83–132.8K / year

Job Summary: The Manager, Utilization Management is responsible for the oversight of all utilization management activities ensuring consistency of…

United States (Remote)

$63.1–94.7K / year

Thank you for considering a career at Ensemble!

United States (Remote)

$34.00 – $61.00 / hour

Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals.

United States (Remote)

$65–70K / year

Scope: The Medical Review Specialist is a Registered Nurse who conducts the Utilization Review process by obtaining medical information and…

United States (Remote)

$56.4–90.4K / year

Job Summary: Complex Population Service Determination Specialist II is responsible for processing medical necessity and noncommunity supports and…

Riverside, California, US (Hybrid)

Job Description Job Summary Provides support for clinical facility site reviews.

United States (Remote)

About the Role We are seeking Registered Nurses with at least 5 years of clinical experience — bedside nursing, case management, clinical nurse…

United States (Remote)

Welcome! We’re excited you’re considering an opportunity with us!

New Hampshire, US (Hybrid)

$31.00 – $55.00 / hour

Position Purpose: Provides expertise based on experience with identifying, overseeing, and managing the coordination of transition of members in the community.

United States (Remote)

$55.00 – $65.00 / hour

About the job Mercor connects elite creative and technical talent with leading AI research labs.

United States (Remote)

Overview HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an…

United States (Remote)

$65–88.6K / year

Become a part of our caring community The Licensed Behavioral Health Utilization Management Professional 2 uses behavioral health knowledge and…

United States (Remote)

$73–125K / year

Job Description A bit about this role: The Clinical Readmission Manager is responsible for conducting prepayment and post-payment clinical reviews of…

United States (Remote)

$27.00 – $49.00 / hour

Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating…

United States (Remote)

Summary We are currently hiring for an RN Appeals Analyst to join BlueCross BlueShield of South Carolina.

United States (Remote)

Overview NAH reserves the right to make hiring decisions based on applicants' state of residence if outside the state of Arizona.

United States (Remote)

Overview Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for…

United States (Remote)

$19.00 – $24.00 / hour

Description WHO WE ARE: GlobalHealth is a fast-growing Medicare Advantage HMO health insurer.

United States (Remote)

$34.00 – $61.00 / hour

Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals.

Monterey Park, California, US (Hybrid)

$21.00 – $26.00 / hour

Astrana Health is seeking a dedicated Utilization Management (UM) Coordinator – Denials to join our Denial Department.