Utilization Review jobs

Remote

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3d ago

RN Clinical Auditor - Behavioral HealthLocation: Fully Remote, with occasional travel to Downtown Indianapolis, IN (expenses covered)Job Summary:We are seeking a Registered Nurse Clinical Auditor with extensive Behavioral Health experience to support medical record reviews and billing compliance audits for the Indiana Health Coverage Programs (IHCP). This role evaluates quality of care, reviews medical records and program policies, identifies compliance issues, prepares audit documentation and r

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Contract

Depends on Experience

Applied Behavior Analysis / ABA (Utilization Management)

Remote

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5d ago

Active BCBA (Board Certified Behavior Analyst) certification and state licensure (3+ years of ABA (Applied Behavior Analysis) clinical experience - Required Experience creating and supervising ABA (Applied Behavior Analysis) treatment plans Direct patient care background (dealing with children with Behavior / Autism issues) Utilization Management or insurance review experience strongly preferred Comfortable reviewing medical necessity and authorization requests Familiar with managed care and pay

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Contract

Depends on Experience

Strategic Data Analyst - CICIP-CICIP Program

Cleveland, Ohio

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Today

Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 80.00 Shift: 8:30am - 5:00pm The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's sa

Full-time

Product Manager, Contact Center Modernization Healthcare)

Dallas, Texas

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Today

Product Manager, Contact Center Modernization Healthcare ) Location: St. Louis, MO / Dallas, TX / New York, NY- Hybrid C2C or W2 Position Summary We are seeking a seasoned Senior Product Manager to lead the strategic migration of our legacy contact center platforms (e.g., Avaya) to Amazon Connect, with a specific focus on healthcare payer operations. This role will be responsible for delivering scalable, cloud-native, and intelligent contact center solutions that enhance member and provider e

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Full-time, Part-time, Third Party, Contract

Quality Documentation Improvement Coordinator

San Antonio, Texas

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Today

POSITION SUMMARY/RESPONSIBILITIES Provides support for the Health System?s quality improvement functions through the analysis of data and indicators. Responsible for identifying and monitoring ongoing quality improvement issues and opportunities. Assists in the development of process metrics, data collection tools and presentations of resultant data throughout the Health System. Serve as facilitator/leader of process improvement efforts. Engages with Senior Leadership, Department Directors, Educ

Full-time

Fraud, Waste, and Abuse (FWA) Medical Record Reviewer

Hybrid in Elkridge, Maryland

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6d ago

Fraud, Waste, and Abuse (FWA) Medical Record ReviewerElite Technical is seeking a Fraud, Waste, and Abuse (FWA) Medical Record Reviewer! We are seeking an experienced healthcare fraud investigator and medical record reviewer with expertise in analyzing medical documentation, claims data, provider billing patterns, and regulatory compliance requirements. Skilled in identifying potential fraud, waste, and abuse indicators through detailed record review, coding validation, and investigative researc

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Contract

40 - 50

RN Care Manager

Billings, Montana

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Today

Job DescriptionJob Description: The RN Hospital Care Manager I delivers comprehensive care management services to designated patients, leveraging clinical expertise for screenings, assessments, and evaluations. This role involves developing and implementing patient-centered care plans with shared goals and tailored interventions. The Care Manager collaborates seamlessly with patients, families/caregivers, healthcare providers, payers, community-based providers, and other stakeholders to ensure e

Full-time

Sr Business Analyst / Trainer with Medicaid Pharmacy / PBM expertise

Remote

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3d ago

We are seeking to hire a Sr Business Analyst / Trainer with expertise in Medicare/Medicaid Pharmacy, including specific expertise in PBM (Pharmacy Benefits Management), to join our teams working on a new multi-year awards we have within several State Govt clients, modernizing their Medicare/Medicaid systems. These roles are 100% remote. Being a US Cit is required for working on this program. This position pays a strong salary package with full benefits (including choice of healthcare plans, den

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Full-time

Depends on Experience

Healthcare and Life Sciences Data Specialist, Applied Research Center

No location provided

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Today

Overview About Cornerstone Research Cornerstone Research is at the forefront of economic and financial consulting, delivering the rigorous analytical solutions required to navigate complex disputes. The firm draws from an extensive network of prominent academic and industry experts to support each matter effectively. Pairing a deep understanding of economics and finance with a suite of industry-leading artificial intelligence and machine learning tools, Cornerstone provides clients with a soph

Full-time

Medical Director

Remote

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20d ago

Medical Director (Utilization Management) - Remote, USLocation: Remote (US) Employment Type: Contract-to-Hire Schedule: Full-time, 40 hours/week <>About the RoleWe are seeking an experienced Medical Director to join a physician-led team responsible for utilization management and clinical review activities for a health insurance organization. This role focuses on evaluating medical necessity, appropriateness of care, appeals, and complex case reviews while ensuring compliance with applicable regu

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Contract

180 - 200

Data Center Commissioning Senior Project Manager

Atlanta, Georgia

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Today

Lead the Delivery of Mission-Critical Infrastructure That Powers the World At FST Technical Services, we don't just support projects-we ensure that the most critical facilities in the world perform flawlessly from day one. Our commissioning teams operate in high-performance environments across hyperscale data centers where precision, reliability, and execution are non-negotiable. We are seeking a Senior Project Manager - Data Center Operations (Cx) who thrives in fast-paced environments, leads f

Full-time

USD 145,000.00 - 175,000.00 per year

Data Center Commissioning Manager

Atlanta, Georgia

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Today

Lead the Delivery of Mission-Critical Infrastructure That Powers the World At FST Technical Services, we don't just support projects-we ensure that the most critical facilities in the world perform flawlessly from day one. Our commissioning teams operate in high-performance environments across hyperscale data centers where precision, reliability, and execution are non-negotiable. We are seeking a Commissioning Manager - Data Center Operations (Cx) who thrives in fast-paced environments, leads fr

Full-time

USD 145,000.00 - 175,000.00 per year

Data Center Commissioning Project Manager

Atlanta, Georgia

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Today

Lead the Delivery of Mission-Critical Infrastructure That Powers the World At FST Technical Services, we don't just support projects-we ensure that the most critical facilities in the world perform flawlessly from day one. Our commissioning teams operate in high-performance environments across hyperscale data centers where precision, reliability, and execution are non-negotiable. We are seeking a Project Manager - Data Center Operations (Cx) who thrives in fast-paced environments, leads from the

Full-time

USD 145,000.00 - 175,000.00 per year

Senior Engineer, Agency Planning and Implementation

New York, New York

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Today

Company Description Job Description DCAS's mission is to make city government work for all New Yorkers. From managing New York City's most iconic courthouses and municipal buildings, to purchasing over $1 billion annually in goods and services for more than 80 City agencies what we do ensures that all agencies can deliver on their mission. Our reach touches every facet of city government and is instrumental to the successful day-to-day operations of the City of New York. Our commitment to equ

Full-time

USD 100,000.00 - 125,000.00 per year

Senior Data Extraction Specialist

Temecula, California

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Today

Why We Are - Who We Are: About Enterprises What We Do - ;br> Position Summary The Senior Data Extraction Specialist is responsible for reviewing clinical documentation and accurately extracting and translating pertinent clinical findings into structured data within the InCircle application. This role directly supports the integrity, accuracy, and timeliness of data inputs that drive clinical review workflows and downstream operational processes. Operating within defined guidelines and data sta

Full-time

USD 68,000.00 per year

Mechanical Systems Engineer Intern

Bloomington, Maryland

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8d ago

Onto Innovation is a leader in process control, combining global scale with an expanded portfolio of leading-edge technologies that include: 3D metrology spanning the chip from nanometer-scale transistors to micron-level die-interconnects; macro defect inspection of wafers and packages; metal interconnect composition; factory analytics; and lithography for advanced semiconductor packaging. Our breadth of offerings across the entire semiconductor value chain helps our customers solve their most d

Full-time

Senior Analyst, Delivery Support Analytics

Denver, Colorado

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Today

Thinkfind is seeking a Senior Analyst, Delivery Support Analytics to support healthcare consulting engagements by transforming complex supply cost, utilization, and clinical data into clear, actionable insights. This role plays a critical role in identifying cost savings, reducing unwarranted clinical variation, and supporting data-driven decision-making across Physician Preference Items (PPI) and Med-Surg service lines. The analyst partners closely with consultants and internal stakeholders to

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Contract

USD85,000 - USD95,000

Jr. Business /Data Analyst (Energy, Utility Experience Required)

New York, New York

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Today

Trigyn's direct government client has an immediate need for a Jr. Business /Data Analyst in New York, NY. The details of the opportunity are below. Essential Job Functions: ? Seasoned analyst with years of experience in utility/energy field ? Understanding & Analytic background/experience in utility modeling and forecasting ? Understanding of Utility Market (i.e. Energy/Commodity Options market) and impact analytic ? Unique understanding of energy impact on government sector ? Specifically unde

Contract, Third Party

DOE