Utilization Management Clinical
$50 - $60/hr
Take and triage nursing calls from clinicians, patients, and caregivers as appropriate ... Home Health experience preferred but not required. * Knowledge of Medicare home health regulations ...
$50 - $60/hr
Take and triage nursing calls from clinicians, patients, and caregivers as appropriate ... Home Health experience preferred but not required. * Knowledge of Medicare home health regulations ...
$50 - $60/hr
Take and triage nursing calls from clinicians, patients, and caregivers as appropriate ... Home Health experience preferred but not required. * Knowledge of Medicare home health regulations ...
Travel can vary from 20% to 100% per day. This would include all counties within NTBHA Catchment ... This may include, but is not limited to field & home visits, offsite meetings, co-located sites and ...
Travel can vary from 20% to 100% per day. This would include all counties within NTBHA Catchment ... This may include, but is not limited to field & home visits, offsite meetings, co-located sites and ...
Lincoln, NE · On-site
... from Utilization Management areas of responsibility. 4. Manages the Physician Advisory Services. 5. Utilizes data, analytics and technology solutions to streamline operational efficiencies. 6. *
Lincoln, NE · On-site
... from Utilization Management areas of responsibility. 4. Manages the Physician Advisory Services. 5. Utilizes data, analytics and technology solutions to streamline operational efficiencies. 6. *
Oversees utilization management functions which include timely authorizations related to pre ... If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of ...
Oversees utilization management functions which include timely authorizations related to pre ... If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of ...
O.) from an accredited university Experience * One (1) year of experience in utilization management is required. * Excellent communication and organizational skills required. * Experience in ...
Quick apply
O.) from an accredited university Experience * One (1) year of experience in utilization management is required. * Excellent communication and organizational skills required. * Experience in ...
Oakland, CA · On-site
Their responsibilities span from managing admissions to ensuring clean claims, identifying trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician ...
Oakland, CA · On-site
Their responsibilities span from managing admissions to ensuring clean claims, identifying trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician ...
The Director Utilization Management (Inpatient) provides strategic leadership of the inpatient ... The incumbent will be expected to work a portion of their week from home and a portion of their ...
The Director Utilization Management (Inpatient) provides strategic leadership of the inpatient ... The incumbent will be expected to work a portion of their week from home and a portion of their ...
Oakland, CA · On-site
Their responsibilities span from managing admissions to ensuring clean claims, identifying trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician ...
Oakland, CA · On-site
Their responsibilities span from managing admissions to ensuring clean claims, identifying trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician ...
Glen Burnie, MD · On-site
$406K/yr
Our medical center is home to leading-edge technology, nationally recognized quality, personalized ... Graduation from an accredited nursing education program approved by the Board of Nursing or found ...
Glen Burnie, MD · On-site
$406K/yr
Our medical center is home to leading-edge technology, nationally recognized quality, personalized ... Graduation from an accredited nursing education program approved by the Board of Nursing or found ...
Oakland, CA · On-site
Their responsibilities span from managing admissions to ensuring clean claims, identifying trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician ...
Oakland, CA · On-site
Their responsibilities span from managing admissions to ensuring clean claims, identifying trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician ...
Glen Burnie, MD · On-site
$40.61 - $60.96/hr
Our medical center is home to leading-edge technology, nationally recognized quality, personalized ... Graduation from an accredited nursing education program approved by the Board of Nursing or found ...
Glen Burnie, MD · On-site
$40.61 - $60.96/hr
Our medical center is home to leading-edge technology, nationally recognized quality, personalized ... Graduation from an accredited nursing education program approved by the Board of Nursing or found ...
The Utilization Management Nurse 2 also plays a key role in facilitating comprehensive, proactive ... Remote work at home Location: Must reside in Kentucky or a county that is within contiguous ...
New
The Utilization Management Nurse 2 also plays a key role in facilitating comprehensive, proactive ... Remote work at home Location: Must reside in Kentucky or a county that is within contiguous ...
New
The Utilization Management Nurse 2 also plays a key role in facilitating comprehensive, proactive ... Remote work at home Location: Must reside in Kentucky or a county that is within contiguous ...
New
The Utilization Management Nurse 2 also plays a key role in facilitating comprehensive, proactive ... Remote work at home Location: Must reside in Kentucky or a county that is within contiguous ...
New
New York, NY · Remote
$29.10 - $62.32/hr
Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and ... UM Nurse Consultant Fully Remote- WFH Schedule : Tuesday-Saturday 9:30am-6:00pm Position Summary:
New York, NY · Remote
$29.10 - $62.32/hr
Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and ... UM Nurse Consultant Fully Remote- WFH Schedule : Tuesday-Saturday 9:30am-6:00pm Position Summary:
Wilmington, NC · Remote
Day-to-day management of Utilization Management queues, dashboards, members, ensuring all ... Licensed Registered Nurse credentialed from an accredited school/college with 3-5 years of clinical ...
Wilmington, NC · Remote
Day-to-day management of Utilization Management queues, dashboards, members, ensuring all ... Licensed Registered Nurse credentialed from an accredited school/college with 3-5 years of clinical ...
$35 - $40/hr
The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...
$35 - $40/hr
The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...
... from care management programs and facilitates referral(*) Identifies opportunities to promote ... home health or ambulatory care required. Managed care/utilization review experience preferred ...
... from care management programs and facilitates referral(*) Identifies opportunities to promote ... home health or ambulatory care required. Managed care/utilization review experience preferred ...
Concord, NC · Remote
$35 - $40/hr
The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...
Concord, NC · Remote
$35 - $40/hr
The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...
Concord, NC · Remote
$35 - $40/hr
The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...
Concord, NC · Remote
$35 - $40/hr
The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...
Los Angeles, CA · On-site
$53K - $58K/yr
... thrive in their homes. In this full-time role, you will play a crucial part in ensuring ... Provide comprehensive reports on utilization management activities and outcomes. * Participate in ...
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Los Angeles, CA · On-site
$53K - $58K/yr
... thrive in their homes. In this full-time role, you will play a crucial part in ensuring ... Provide comprehensive reports on utilization management activities and outcomes. * Participate in ...
$47.5K - $56.7K
1% of jobs
$56.7K - $66K
5% of jobs
$73K is the 25th percentile. Wages below this are outliers.
$66K - $75.2K
24% of jobs
The median wage is $80.2K / yr.
$75.2K - $84.4K
35% of jobs
$89K is the 75th percentile. Wages above this are outliers.
$84.4K - $93.6K
18% of jobs
$93.6K - $102.9K
5% of jobs
$102.9K - $112.1K
1% of jobs
$112.1K - $121.3K
1% of jobs
$121.3K - $130.5K
3% of jobs
$130.5K - $139.8K
3% of jobs
$139.8K - $149K
2% of jobs
$47.5K
$89.1K
$149K
| Aspect | From Home Utilization Management Bcba | From Home Behavior Analyst |
|---|---|---|
| Certifications | BCBA or BCaBA, plus utilization management training | BCBA or BCaBA, with behavior analysis certification |
| Work Environment | Utilization review, insurance companies, healthcare settings | Behavior therapy, client homes, clinics, schools |
| Employer & Industry Usage | Health insurance providers, managed care organizations | Behavior analysis agencies, educational institutions |
From Home Utilization Management Bcba focuses on reviewing and approving treatment plans within healthcare and insurance settings, often involving utilization review. In contrast, From Home Behavior Analyst primarily provides direct behavioral therapy and assessments to clients, often in home or clinical environments. Both roles require BCBA certification but differ in daily tasks and work settings.
The Utilization Manager, Registered Nurse, is an office-based nursing position responsible for supporting high-quality patient care through clinical oversight, utilization management, and real-time guidance to field clinicians. This role serves as a key clinical resource within the organization, assisting with nursing calls, care coordination, and clinical decision-making to promote positive patient outcomes while ensuring regulatory and payer compliance.
Key responsibilities include:
Provide clinical support and guidance to field clinicians, including RNs, LVNs, and therapy staff.
Take and triage nursing calls from clinicians, patients, and caregivers as appropriate.
Collaborate with field staff to assist with clinical problem-solving, patient status changes, and care planning.
Review plans of care and clinical documentation to ensure appropriate utilization of services and skilled need.
Monitor visit frequencies and service utilization in alignment with physician orders, payer guidelines, and agency standards.
Support case managers with recertifications, discharges, transitions of care, and care coordination.
Participate in interdisciplinary collaboration to promote continuity of care and effective communication.
Identify clinical risks or concerns and escalate issues appropriately.
Support compliance with Medicare Conditions of Participation, regulatory requirements, and agency policies.
Contribute to quality improvement initiatives focused on patient outcomes, documentation accuracy, and clinical best practices.
Required Qualifications
Active Registered Nurse (RN) license in the state of California.
Strong clinical assessment, critical-thinking, and decision-making skills.
Excellent verbal and written communication skills.
Ability to work collaboratively with interdisciplinary teams.
Proficiency with electronic medical records (EMR) systems and basic computer applications.
Preferred Qualifications
Experience in utilization management, case management, or clinical coordination.
Home Health experience preferred but not required.
Knowledge of Medicare home health regulations, payer guidelines, and Conditions of Participation.
Experience providing clinical support, education, or mentorship to field clinicians.
Strong organizational skills with the ability to manage multiple priorities in a fast-paced office environment.
Sourced by ZipRecruiter
Home health care services
51 - 200 Employees
Chico, CA, US
1984