12 Utilization Management Guidelines jobs

West Virginia, United States (Remote)

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

California, United States (Remote)

JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes.

New Jersey, United States + 4 more (Remote)

$79.1–105.9K / year

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.

Florida, United States (Remote)

$78–82K / year

Our Story Imagine being part of a team that’s not just shaping the future but actively driving it.

Georgia, United States (Remote)

$65K / year

At Broadway Ventures , we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions.

Arkansas, 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…

Harrisburg, Pennsylvania, US (Hybrid)

Category: Health Care Location: Harrisburg Pennsylvania United States Are you a registered nurse ready to take your career in an exciting new…

Colorado, United States + 16 more (Remote)

$66–68K / year

Role Snapshot The Appeals Nurse examines medical records and claims information for first-level appeal cases to determine whether services provided…

South Carolina, United States (Remote)

Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or…

Alabama, United States + 28 more (Remote)

$89.5–136.5K / year

City/State Fairfax, VA Work Shift First (Days) Overview: Sentara Health is looking to hire an Integrated Case Manager, RN.

United States (Remote)

Molina Healthcare is hiring a remote RN Care Manager.

Wisconsin, United States (Remote)

The Quality Care Coordinator develops, implements and provides ongoing monitoring of intervention plans and quality gap closure.