Utilization coordinator jobs near me - 298 jobs

Job DescriptionKENTECH Consulting Inc. is an award-winning background technology screening company. We are the creators of innovative projects such as eKnowID.com, the first consumer background checking system of its kind, and ClarityIQ, a high-tech and high-touch investigative case management system. MISSION We're on a mission to help the world make clear and informed hiring decisions. VALUE In order to achieve our mission, our team exhibits the behaviors and core values aligned with it. *********************************** Customer Focused: We are customer-focused and results-driven. Growth Minded: We believe in collaborative learning and industry best practices to deliver excellence. Fact Finders: We are passionate investigators for discovery and truth. Community and Employee Partnerships: We believe there is no greater power for transformation than delivering on what communities and employees care about. IMPACT As a small, agile company, we seek high performers who appreciate that their effort will directly impact our customers and help shape the next evolution of background investigations. Are you a highly organized and detail-oriented professional who thrives in a fast-paced environment? Do you enjoy ensuring smooth communication between departments and maintaining accurate, precise information? KENTECH Consulting Inc. is seeking a customer-focused Intake Specialist to serve as the first point of contact in our background investigation process. In this role, you will play a critical part in ensuring timely and efficient service delivery by facilitating seamless case intake and handoff. Key Responsibilities Case Intake and Data Management, serve as the initial point of contact for incoming background check requests, ensuring accurate data capture and case setup. Interdepartmental Coordination, work closely with Investigative Analysts and Verifications teams to ensure smooth handoffs and consistency in service delivery. Data Validation and Accuracy, review and validate incoming client information and address missing details to minimize delays. Case Management and Record Keeping, maintain accurate intake records in ClarityIQ, our case management system. Prioritization and Time Management, manage intake tasks based on client requirements, service standards, and deadlines. Client Communication and Support, engage with clients to clarify initial information and support strong relationships and proactive communication. Process Improvement, contribute to enhancements in intake processes to improve efficiency and client satisfaction. Qualifications and Experience One or more years of experience in intake, customer service, or administrative roles. Experience in healthcare, social services, legal, or background screening is a plus. Strong attention to detail and accuracy in data entry and record keeping. Effective written and verbal communication skills with a customer-first mindset. Tech savvy, comfortable using case management systems or CRM software. Experience with ClarityIQ is a plus. Ability to adapt to evolving processes and priorities in a dynamic work environment. Desired Soft Skills Critical thinking and the ability to evaluate information accurately and make informed decisions. Clear communication in both verbal and written interactions with clients and team members. Strong attention to detail and commitment to accurate data handling. Team collaboration and the ability to work cooperatively across departments. Problem solving with a proactive approach to addressing challenges and improving processes. Why Join KENTECH? Remote and flexible work that allows you to support a fast-growing team. Professional development opportunities and training for career growth. The chance to make a meaningful impact in a mission-driven company that values accuracy, efficiency, and innovation. Apply Now If you are a detail-oriented professional with a passion for client service and operational efficiency, we want to hear from you. KENTECH Consulting Inc. is an equal opportunity employer. We celebrate diversity and remain committed to fostering an inclusive workplace. This is a remote position.

BGE is looking to hire a TXDOT Utility Coordination Engineer PM (P.E.) for our Transportation systems dept. BGE, Inc. is a nationwide consulting firm that provides services in civil engineering, planning, landscape architecture, construction management, survey, and environmental services for public and private clients. Our employees enjoy a comprehensive benefits package such as outstanding health care, generous 401(k) match, career mapping and highly competitive time away from work programs to include remote work options, dependent care, and flexible Fridays. Locations: 2595 Dallas Pkwy #101, Frisco, TX 75034 Responsibilities: Project Manager for Utility Coordination/engineering projects. Direct responsibility for Subsurface Utility Engineering (SUE) and utility coordination/ engineering projects. Overseeing the preparation of existing SUE utility plans. Providing quality assurance/quality control (QA/QC) reviews of field data and deliverables. Conduct meetings, prepare agreements and/or cost estimates, review design plans, specifications and other submittals. Designs and reviews utility relocation plans to comply with federal, state, and local laws and regulations. Preferred: Designing and reviewing utility relocation plans in compliance with federal state and local laws and regulations, by becoming well versed with the interpretation of: TXDOT's Utility Accommodation Rules TXDOT's Utility Manual, TXDOT's Roadway Design Manual, TXDOT's Manual on Uniform Traffic Control Devices (TMUTCD), CRF 645 Subparts A & B (Code of Federal Regulations of Utilities) AREMA (American Railway Engineering and Maintenance Association) Requirements: Licensed Texas Professional Engineer (PE) Bachelor's Degree in Civil Engineering or related field 5+ years of experience preferred Proficient in MicroStation and MS Office, Knowledgeable of Geopak Position requires strong communication skills, scheduling, problem-solving skills and presentation skills Ability to simultaneously perform, track, prioritize, and coordinate challenges across multiple projects, multiple utility owners and professionals Situational problem-solving abilities with various utility engineering circumstances and with multiple stake holders Ability to train and lead less experienced utility EIT staff Benefits to name a few… Established company with a diverse range of projects we work on, a flexible work environment and a collaborative atmosphere. No Silos (ability to flex to other groups, share resources and learn their business) Best work life balance in the industry! Unlimited Sick Leave (9/80) schedule choice - have every other Friday off. 3% Safe Harbor contribution 4% 401k Match with immediate vesting Merit Based Bonus Compensation Medical, Dental, Vision 9 Holidays 6 Weeks of work from anywhere program. Personal time Allowances (no time deducted for Dr appointments, family care, 32 hour dependent care, etc) 240 Vacation carry over time. 0-5 years in industry 2 weeks' vacation, 5-10 gets 3 weeks, 10+ gets 4 weeks. Flex time - Start from the hours of 7a - 9a Mentorship Program - Mentoring Program is to provide our Mentors the opportunity to gain a sense of fulfillment and personal growth, and our Mentees with the opportunity to learn and receive guidance from seasoned professionals. Employee referral program for bringing great people into the BGE family Not accepting non-resident applicants or Sponsorships. BGE is an equal opportunity employer and values diversity. We prohibit discrimination and all employment is decided based on qualifications, merit and business need. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin or any other classification protected by federal, state or local laws. BGE, Inc. is a nationwide consulting firm that provides services in civil engineering, planning, landscape architecture, construction management, survey, and environmental services for public and private clients. Our employees enjoy a comprehensive benefits package such as outstanding health care, generous 401(k) match, career mapping and highly competitive time away from work programs to include remote work options, dependent care, and flexible Fridays.

Current Saint Francis Employees - Please click HERE to login and apply. This position is ECB status - requires a minimum number of worked hours per month as needed by the department; limited benefit offerings. #ALDIND The shift for this role would be as needed during the weekdays. Location: Remote Job Summary: Provides administrative and clinical support to the hospital and treatment team throughout the review of patients, their placement in various levels of care and their receipt of necessary services and appropriate discharge planning. UM Coordinators participate in treatment teams, communicating with providers the details of reimbursement issues; also participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal processes. Provides staff education as needed to further the goals of UR. Minimum Education: Has completed the basic professional curricula of a school of nursing as approved and verified by a state board of nursing, and holds or is entitled to hold a diploma or degree therefrom or Master's degree in Social Work, Counseling or related behavioral health field. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker (LCSW), or Professional Counselor (LPC) license, or Marriage and Family Therapist (LMFT). Work Experience: 3 - 4 years of related experience in behavioral health care, part of which may be experience in Behavioral health managed care. Knowledge, Skills and Abilities: Working knowledge of Microsoft Word, Excel and Access as might be used in the preparation of correspondence and reports. Effective interpersonal, written and oral communication skills. Ability to integrate the analysis of data to discover facts or develop knowledge, concepts or interpretations. Ability to organize and prioritize work in an effective and efficient manner. Ability to be detail oriented as required in the examination of numerical data. Ability to synthesize clinical case data into concise summaries. Essential Functions and Responsibilities: Meets time requirements for review intervals, supplying the required clinical information to obtain authorization. Responds promptly to authorizing entity's need for further detail. Participates in treatment team or Patient Care Committee, providing information about eligibility, benefits and criteria for the selected level of care. Seeks treatment information for use in providing reviews for authorization of services. Contributes to discharge planning. Participates in quality of care process improvement. Identifies QI Triggers for individual patient situations, reporting them promptly to the Process Improvement/Quality Director, to appropriate clinicians and to the UM Manager. Reviews eligibility and benefits of patients, matching the level of care utilization. Assures compliance with Managed Care Behavioral Health standards in the area of UM procedures and documentation to permit accreditation for Laureate and/or to maintain the delegation standards established by the managed care contracts. Investigates and prepares appeals for insurance companies, when denial of reimbursement is related to medical necessity or to other treatment issues. Participates in UM process improvement on an ongoing basis and participates in the UR Staff Committee's process improvement goals. Decision Making: The carrying out of non-routine procedures under constantly changing conditions, in conformance with general instructions from supervisor. Working Relationship: Works directly with patients and/or customers. Works with internal customers via telephone or face to face interaction. Works with external customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above. Special Job Dimensions: None. Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties. Pre-Arrival - Yale Campus Location: Tulsa, Oklahoma 74136 EOE Protected Veterans/Disability

Oncology Utilization Review State Medical Licenses required: Florida, Minnesota or Oregon Flexible Independent Contractor (1099) Opportunity Founded in 1983, Medical Review Institute of America (MRIoA) is a nationally recognized Independent Review Organization (IRO) specializing in technology-driven utilization management and clinical medical review solutions. We're a leader in Peer and Utilization Reviews, known for excellence and continuous improvement. THE OPPORTUNITY: We are currently seeking Board-Certified physicians in Oncology to conduct independent Utilization Reviews. This is a flexible, fully remote opportunity requiring just 1-2 hours per week-with no minimum commitment. ADDITIONAL INFORMATION: Work remotely from anywhere in the US (Per HIPPA Regulations patient records cannot leave the US). Covered under MRIoA's Errors and Omissions policy. Independent Contractor (1099) opportunity. Workers are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information. California Consumer Privacy Act (CCPA) Information (California Residents Only): Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver's license number, or state identification card number, and passport number. Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at ************. Must have a Medical Degree MD or DO Must have a current State Medical License in one of the following: Florida, Minnesota or Oregon Current Board Certification in Medical Oncology Must have 5 years of clinical experience, Residency can be included Daytime availability is required for peer-to-peer conversations

ARIZONA DEPARTMENT OF ADMINISTRATION Delivering results that matter by providing best in class support services. Fixed Asset Coordinator Job Location: Division of Business and Finance (DBF) This position is 100% in office 8am to-5pm M-F Address: 100 N 15th Avenue, Suite 302, Phoenix, AZ 85007 Posting Details: Salary: Up to $51,394.00 Grade: 19 Open Until Business Needs Are Met First Review of Resumes 1/23/2026 Job Summary: The Arizona Department of Administration (ADOA), Division of Business and Finance (DBF), is seeking a Fixed Asset Coordinator. This vital role involves meticulously managing all agency fixed assets, encompassing their acquisition, disposal, tracking, and reconciliation within systems like AZ360 and BarScan. You'll be instrumental in maintaining accurate asset records, ensuring compliance with established policies, and playing a key role in supporting agency-wide inventory and audit initiatives. This position requires close collaboration with divisional property coordinators to fulfill both non-capital and capital inventory requirements, generate essential reports for audits and leadership, and promptly respond to data requests. You will also lead annual audits and special projects, guaranteeing accurate location data and timely communication of updates to relevant divisions. Job Duties: Maintain accurate and current fixed asset records for the agency. Record all asset acquisitions and disposals within AZ360 and Barscan. Attach all required backup documentation to transactions. Ensure that fixed asset records in all systems reflect accurate descriptions, custodian assignments, and locations Accurately record all disposal requests in both AZ360 and Barscan. Maintain detailed and traceable disposal records to support audit and reporting requirements. Conduct research and follow up with divisional property coordinators and division contacts to obtain necessary information for asset entries. Monitor and resolve inconsistencies or duplicate entries across systems Establish, update, or relabel asset location codes in Barscan, AZ360, and other designated agency systems. Create new location codes when office spaces are added, reconfigured, or relocated to ensure each asset is assigned to the correct physical location Generate reports from AZ360, BarScan, or other systems to support audits, inventories, and leadership requests. Respond to asset-related data requests quickly and accurately. Lead annual audits and special projects related to agency-wide asset management, ensuring compliance with inventory requirements and asset tracking policies Work closely with divisional property coordinators and support teams to gather information and ensure data accuracy. Provide regular and ad hoc fixed asset reports to division coordinators and agency leadership. Ensure timely communication of updates or required actions to relevant divisions Provide administrative support as a back up to GAO front desk as needed. Knowledge, Skills & Abilities (KSAs): Knowledge of: Demonstrated understanding of the AZ360 enterprise resource planning system, particularly as it relates to fixed asset tracking, inventory management, and financial documentation within a state government environment Working knowledge of fixed asset policies outlined in the SAAM, including guidelines for capitalization, depreciation, tagging, transfers, and disposal of state-owned assets to ensure compliance with state accounting and reporting standards Skills in: Strong written communication skills to prepare accurate documentation, reports, emails, and training materials Exceptional time management and prioritization abilities to handle multiple ongoing tasks and deadlines Strong collaboration skills to work cross-functionally across divisions Capable of working independently with minimal supervision while remaining highly productive Ability to: Generate reports and analyze data using spreadsheets and reporting tools Build and maintain effective working relationships with internal staff, divisional property coordinators, leadership, and external partners Establish and maintain filing systems, track project milestones, and ensure follow-through on outstanding items Set goals, define timelines, and manage resources effectively Selective Preference(s): Two years of responsible administrative experience at or above the Administrative Assistant III level. This experience should be in fields such as personnel, budget analysis, purchasing, accounting, data processing, or similar administrative services work A Master's degree in business or public administration from an accredited college or university can substitute for one year of the required experience Pre-Employment Requirements: Background and reference check, including a criminal records verification If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver's License Requirements. All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify). Benefits: The Arizona Department of Administration offers a comprehensive benefits package to include: Sick leave Vacation with 10 paid holidays per year Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program) Health and dental insurance Retirement plan Life insurance and long-term disability insurance Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion. Learn more about the Paid Parental Leave pilot program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page Retirement: Participation in ASRS Lifetime Benefit Pension Plan after 26 weeks of employment Contact Us: If you have any questions please feel free to contact Christopher Langseth at ****************************** for assistance The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer

For ambitious, culturally diverse, curious minds seeking booming careers, Job Duck unlocks and nurtures your potential. We connect you with rewarding, remote job opportunities with US-based employers who recognize and appreciate your skills, allowing you to not just survive but thrive. As a lifestyle company, we ensure that everybody working here has a fantastic time, which is why we've earned the Great Place to Work Certification every year since 2022! Job Description: Join Job Duck as an Client Intake Coordinator and become the first point of contact for prospective clients. In this role, you'll manage the intake process, schedule consultations, and ensure a seamless experience for every client. You'll play a vital part in building trust and clarity from the very first interaction, while confidently handling paid consultations and payment collection. This position is ideal for someone with excellent communication skills, a clear and professional accent, and a proactive approach to client engagement. If you thrive in a structured environment and enjoy making a positive impact on client relationships, this role is for you. Monthly Salary Range: 1,150 to 1,220 USD Responsibilities include, but are not limited to: Provide exceptional client experience from first contact onward Maintain accurate records in CRM systems Inform clients about paid consultations and manage payment collection Collaborate with internal teams to ensure smooth onboarding Communicate clearly and professionally with clients Handle client intake and ensure accurate information collection Schedule consultations promptly and efficiently Requirements: Excellent communication skills At least 1 year of experience in sales Detail-oriented and organized Strong sales aptitude Ability to manage scheduling and intake processes Proactive and client-focused mindset Tech-savvy with CRM and VOIP tools Comfortable discussing paid consultations and collecting payments Ability to manage scheduling and intake processes Work Schedule: Monday-Friday Expected call volumes: Calls may be involved Location: Remote Mountain Standard Time [MST] Work Shift: 8:00 AM - 5:00 PM [MST][MDT] (United States of America) Languages: English, Spanish Ready to dive in? Apply now and make sure to follow all the instructions! Our application process involves multiple stages, and submitting your application is just the first step. Every candidate must successfully pass each stage to move forward in the process. Please keep an eye on your email and WhatsApp for the next steps. A recruiter will be assigned to guide you through the application process. Be sure to check your spam folder as well.

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. ESSENTIAL JOB DUTIES: Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions. Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. Identifies and reports quality of care issues. Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience. Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings. Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. Supplies criteria supporting all recommendations for denial or modification of payment decisions. Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. Provides training and support to clinical peers. Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols. REQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice. Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). Experience working within applicable state, federal, and third-party regulations. Analytic, problem-solving, and decision-making skills. Organizational and time-management skills. Attention to detail. Critical-thinking and active listening skills. Common look proficiency. Effective verbal and written communication skills. Microsoft Office suite and applicable software program(s) proficiency. PREFERRED QUALIFICATIONS: Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications. Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics. Billing and coding experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Become a part of our caring community and help us put health first Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we're seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others. Preferred Locations: Daytona, FL, Louisville, KY, San Antonio, TX Use your skills to make an impact Role Essentials Active Unrestricted RN license Possession of or ability to obtain Compact Nursing License A minimum of three years clinical RN experience; Prior clinical experience, managed care experience, DME, Florida Medicaid OR utilization management experience Demonstrates Emotional Maturity Ability to work independently and within a team setting Valid driver's license and/or dependable transportation necessary Travel for offsite Orientation 2 to 8 weeks Travel to offsite meetings up to 6 times a year as requested Willing to work in multiple time zones Strong written and verbal communication skills Attention to detail, strong computer skills including Microsoft office products Ability to work in fast paced environment Ability to form positive working relationships with all internal and external customers Available for On Call weekend/holiday rotation if needed Role Desirables Education: BSN or bachelor's degree in a related field Experience with Florida Medicaid Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures Compact License preferred Previous experience in utilization management within Insurance industry Previous Medicare Advantage/Medicare/Medicaid Experience a plus Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. Bilingual Additional Information We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k with company matching, tuition reimbursement, 3 weeks paid vacation time, paid holidays, work-life balance, growth, a positive and fun culture and much more. To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 02-18-2026 About us About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse is responsible for ensuring the receipt of high quality, cost efficient medical outcomes for those enrollees with a need for inpatient/ outpatient authorizations. This position receives and reviews prior authorization requests for specific inpatient and outpatient medical services, notification of emergent hospital admissions, completes inpatient concurrent review, establishes discharge plans, coordinates transitions of care to lower/higher levels of care, makes referrals for care management programs, and performs medical necessity reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well as specified clinical guidelines/criteria to guide medical necessity reviews and will use effective relationship management, coordination of services, resource management, education, patient advocacy and related interventions to ensure members receive the appropriate level of care, prevent or reduce hospital admissions where appropriate. Job Description PRIMARY DUTIES AND RESPONSIBILITIES Employees are expected to work consistently to demonstrate the mission, vision, and core values of the organization. Key Outcomes: * Review prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed for additional expertise and review. * Utilize evidenced-based criteria, governmental policies, and internal guidelines for medical necessity reviews. * Manage the review of medical claims disputes, records, and authorizations for billing, coding, and other compliance or reimbursement related issues * Collaborates with other members of the team, the MPHC Medical Directors, healthcare providers, and members to promote effective utilization of resources. This collaboration includes timely communications with in and out of network hospitals, post-acute care facilities, other providers, and internal departments to authorize services, establish discharge plans, assist to coordinate effective, efficient transitions of care. * Coordinates referrals to Care Management, as appropriate. * Manages health care within the benefits structures per line of business and performs functions within compliance, contractual and accreditation regulations, e.g. Department of Defense, Centers for Medicaid and Medicare, NCQA, Employer contracts and state insurance regulations, as applicable. Maintains knowledge of applicable regulatory guidelines. * Completes all documentation of reviews and decisions, in appropriate systems, according to process/ compliance requirements and within timeliness standards. * Participates as a member of an interdisciplinary team in the Health Management Department * May be responsible for maintaining a caseload for concurrent cases/ assisting in caseload coverage for the team * Establishes and maintains strong professional relationships with community providers. * Acts as a liaison to ensure the member is receiving the appropriate level of care at the appropriate place and time * Mentors new staff as assigned. * Meets or exceeds department quality audit scores. * Meets or exceeds department productivity standards. * Assists in creation and updating of department policies and procedures. * Participates in quality initiatives, committees, work groups, projects, and process improvements that reinforce best practice medical management programming and offerings. * Participates in the review and analysis of population data and metrics to inform development of programs and improved health outcomes. * Demonstrates flexibility and agility in working in a fast-paced, team-oriented environment, able to multi-task from one case type to another. * Assumes extra duties as assigned based on business needs * Responsible for weekend coverage on a rotating basis. POSITION QUALIFICATION Education/Experience There are additional competencies linked to individual contributor, provider, and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position. Education * Associate's degree in nursing * Bachelor's degree in nursing preferred Licensure/certification * Compact RN license Experience * 3+ years of clinical nursing experience as an RN, preferably in a hospital setting * 2+ years Utilization Management experience in a health plan UM department * Certification in managed care nursing or care management (CMCN or CCM) preferred * Coding/CPC preferred Knowledge * Demonstrates an understanding of and alignment with Martin's Point Values. * Maintains current licensure and practices within scope of license for current state of residence. * Maintains knowledge of Scope of Nursing Practice in states where licensed. * Thorough understanding of healthcare policies, insurance guidelines, and regulatory standards (e.g., Medicare, NCQA, TRICARE) * Familiarity with coding systems like ICD-10 and CPT preferred Skills * Proficiency in conducting prospective, concurrent, and retrospective reviews using standardized criteria and guidelines like MCG * Ability to review and interpret medical records, treatment plans, and clinical documentation, with a keen eye for detail and compliance with healthcare standards * Technically savvy and can navigate multiple systems and screens while working cases * Excellent interpersonal, verbal, and written communication skills. * Critical thinking: can identify root causes and understands coordination of medical and clinical information. * Computer proficiency in Microsoft Office products including Word, Excel, and Outlook. Abilities * Ability to analyze data metrics, outcomes, and trends. * Ability to prioritize time and tasks efficiently and effectively. * Ability to manage multiple demands. * Ability to function independently. This position is not eligible for immigration sponsorship. We are an equal opportunity/affirmative action employer. Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact ***************************** Do you have a question about careers at Martin's Point Health Care? Contact us at: *****************************

The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days. They are accountable for a designated patient caseload and provides intervention, coordination to decrease avoidable delays, denial of reimbursement. Specific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry. Facilitates communication between payers, review agencies, healthcare team. Identify delays in treatment or inappropriate utilization and serves as a resource. Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates to resolve payer issues. Ensures/Maintains effective communication with Revenue Cycle Departments. Estimated salary range for this position is $73860.80 - $96019.04 / year depending on experience. Degrees: * Associates. Licenses & Certifications: * MCG Care Guidelines Specialist. * Registered Nurse. Additional Qualifications: * RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN. however, they are required to complete the BSN within 3 years of job entry date. * MCG Specialist Certification ISC/HRC required within 12 months of job entry date. * 3 years of Nursing experience preferred. * Excellent written, interpersonal communication and negotiation skills. * Strong critical thinking skills and the ability to perform clinical/chart review abstract information efficiently. * Strong analytical, data management and computer skills. * Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components. * Current working knowledge of payer and managed care reimbursement preferred. * Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families. * Knowledgeable in local, state, and federal legislation and regulations. * Ability to tolerate high volume production standards. Minimum Required Experience: 3 Years of Utilization Review in an acute care setting required

Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care. Key Responsibilities Conduct prospective, concurrent, and retrospective drug utilization reviews. Evaluate prescribing patterns against clinical guidelines and formulary criteria. Identify potential drug interactions, duplications, and inappropriate therapy. Prepare recommendations for prescribers to optimize therapy and reduce risk. Document reviews and ensure compliance with state, federal, and health plan requirements. Contribute to quality improvement initiatives and pharmacy program development. What You'll Bring Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree. Licensure: Active and unrestricted pharmacist license in the U.S. Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply. Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication. Why This Role? Impact: Shape prescribing decisions that affect thousands of patients. Growth: Build expertise in managed care and population health pharmacy. Flexibility: Many DUR roles offer hybrid or fully remote schedules. Rewards: Competitive salary, benefits, and career advancement opportunities. About Us We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations. Apply Today Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.

$40/hour - Contract for 6 months Must reside in TX Full time remote Candidates must be based in TX. RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. pay rate is $40/hour This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies eligibility. Determines benefit levels in accordance to contract guidelines. Provides information regarding utilization management requirements and operational procedures to members, providers and facilities. Registered Nurse (RN) with valid, current, unrestricted license in the state of operations. * 3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company. * Knowledge of medical terminology and procedures. * Verbal and written communication skills. PREFERRED JOB REQUIREMENTS: * Utilization management experience * MCG or InterQual experience

Are you a friend, family or former colleague of someone on the Genesis Digital team? Would you like to join our fully remote company? If we don't have any specific job openings, you can still submit your applications here, and we'll review it as positions become available.

RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. JOB RESPONSIBILITIES: This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies eligibility. Determines benefit levels in accordance to contract guidelines. Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities. JOB QUALIFICATIONS (Required): Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company. Knowledge of medical terminology and procedures. Verbal and written communication skills. JOB QUALIFICATIONS (Preferred): MCG or InterQual experience Utilization management experience LOCATION: REMOTE in Texas (Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties). POSITION: 6-month assignment SALARY: $38 - $40 hourly HOURS PER WEEK: 40 HOURS PER DAY: 8

Join LifeLink - Join a Life Saving Team! About LifeLink More than four decades ago, a visionary group of innovators, led by renowned nephrologist Dr. Dana Shires, made a life-changing commitment-to save lives through organ and tissue donation. From that bold beginning, LifeLink Foundation was established - founded with heart, purpose, and a mission that still guides us today. What started as a nonprofit with big dreams has grown into a vision-driven organization of more than 700 dedicated professionals across west-central Florida, Georgia, parts of South Carolina, Puerto Rico, and the US Virgin Islands. At LifeLink, we are united by our mission: To honor donors and save lives through organ and tissue donation. Our vision remains clear: To maximize the gift of life while giving hope to donor families and transplant patients. We are grounded in the values that shape our work and culture-Compassion. Excellence. Legacy. People. Quality. If you're inspired by purpose, driven by impact, and ready to help save and heal lives, LifeLink is the place for you. What You'll Do As a Remote Referral Coordinator, you will directly contribute to LifeLink's life-saving mission. Primary responsibility is to evaluate and respond to hospital referrals for the purpose of determining a potential organ/tissue donor. Apply LifeLink's policies and procedures in performing and documenting the timeliness of referrals, response to referrals and provide direction to responding staff. In addition, ascertain information to help facilitate the determination of potential donors, BD, DCD potential, medical suitably and order of priority/NOK. Participate in call schedule rotation to ensure coverage of this position's responsibilities 24/7. Effectively communicate with Hospitals, AOC, MDOC, other management staff, FCC, TC, IHC and other development staff. Key Responsibilities: Participate in the RC call schedule coordinating FCC/IHC/HD/TC for making an appropriate and timely onsite visit for referrals in collaboration with AOC. Referral responsibilities will consist of but may not be limited to: Referral evaluation Preliminary determination of suitability Verification of name, race, sex, DOB and location of next-of-kin Accessing Donor Registry Notifying the FCC and other on call team members of potential donor situations Review information on initial referral regarding donation process with hospital personnel with outline of plan. Ability to first mention or assist in authorization / donor designation if applicable Post initial referral: Monitor referrals daily and more often if indicated Maintain documentation on active referrals (weblog) Passing referral call to oncoming RC according to set protocols in order to assure all active referrals are up to date and followed appropriately. Provide follow-up to appropriate Hospital Development Liaison, AOC/IHC/FCC or other vascular staff Follow up with CSD and Tissue Screener for referrals that are going to be immediately extubated and not a candidate for organ donation Receive and handle or appropriately triage miscellaneous calls from CSD (Positive cultures, FH, ME, family issues, etc.). Assist when appropriate in the orientation of new staff at the direction of Manager/ Assistant Manager of FCC program. Meet deadlines for any assigned projects. Participate actively in hospital development initiatives. Apply for continuing education courses and seminars necessary to obtain appropriate CEUs to obtain/maintain certifications and licenses. Participate regularly in OPO & FCC/RC meetings. Other duties as assigned by Director of Recovery Services or immediate supervisor. Who You Are Passionate about helping others and making a difference Aligned with LifeLink's core values of Compassion, Excellence, Legacy, People, and Quality Minimum of one year in a related LifeLink position and/or appropriate credentialing and experience which may include medical-related degree/certification (RN) or appropriate experience in a medical environment. Completion of all requirements of the probationary level position or other related experience/position. Demonstrated above average verbal communication skills and phone etiquette skills. Availability to handle rotation of 24/7 call responsibilities and a work schedule that may require response to emergency back-up call coverage. Understanding that confidentiality must be maintained, according to Foundation protocols. A collaborator who thrives in a mission-first environment Working Conditions: Local/State auto/air travel is required. Variable/rotation on-call days/hours including nights/weekends/holidays depending on call schedule and call duration. Possible high stress / extended hours while on call. Friendly, team-oriented and interactive environment. OSHA Risk Classification: Low Why LifeLink? Be part of an organization with a legacy of saving lives and giving hope Join a passionate and supportive team across Florida, Georgia, and Puerto Rico COMPANY PAID Medical, Dental, Disability & Life Insurance Generous COMPANY PAID Pension Plan for your Retirement Paid Vacation, Sick Days & Holidays Growth opportunities in a mission-driven, high-impact nonprofit Work with purpose, knowing your efforts directly touch lives Diversity, Equity & Inclusion LifeLink is proud to be an equal opportunity employer. We celebrate diversity and are committed to building an inclusive environment that reflects the communities we serve. Ready to Help Change Lives? Your next career move could be the most meaningful one yet.

Utilization Review Registered Nurse, Case Management, FT, 08A-4:30P Local Remote-155674Description The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days. They are accountable for a designated patient caseload and provides intervention, coordination to decrease avoidable delays, denial of reimbursement. Specific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry. Facilitates communication between payers, review agencies, healthcare team. Identify delays in treatment or inappropriate utilization and serves as a resource. Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates to resolve payer issues. Ensures/Maintains effective communication with Revenue Cycle Departments.Qualifications Degrees:Associates.Licenses & Certifications:MCG Care Guidelines Specialist.Registered Nurse.Additional Qualifications:RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN. however, they are required to complete the BSN within 3 years of job entry date.MCG Specialist Certification ISC/HRC required within 12 months of job entry date.3 years of Nursing experience preferred.Excellent written, interpersonal communication and negotiation skills.Strong critical thinking skills and the ability to perform clinical/chart review abstract information efficiently.Strong analytical, data management and computer skills.Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.Current working knowledge of payer and managed care reimbursement preferred.Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families.Knowledgeable in local, state, and federal legislation and regulations.Ability to tolerate high volume production standards.Minimum Required Experience: 3 YearsJob Case Management/Home HealthPrimary Location Boca RatonOrganization Boca Raton Regional HospitalSchedule Full-time Job Posting Jan 7, 2026, 5:00:00 AMUnposting Date Ongoing Pay Grade R21EOE, including disability/vets

We are seeking a dedicated and compassionate Wound Care Nurse, Telehealth Coordinator within the skilled nursing environment. The Wound Care Nurse, Telehealth Coordinator is the link between healthcare providers and patients while providing dressing changes to wounds, under direct supervision, utilizing real-time, imaging technologies. If you are passionate about excellent wound care and recognize the role telehealth has for consistent, convenient attention to patients in need, we encourage you to apply for the Telehealth Coordinator position and join our dedicated team. Responsibilities: Act as the in-person, hands on assistant to conduct weekly virtual wound rounds using technology under the guidance of wound care specialists, nurses, or healthcare providers. Photograph wounds using designated telehealth technology and ensure accurate documentation of images for clinical review. Aid patients in navigating telehealth platforms, troubleshoot technical issues, and ensure a seamless virtual connection for appointments. Facilitate patient telehealth scheduling, provide education on virtual visits to patients and staff as needed. Administer all aspects of wound care as per evidence based practice and facility policies, including dressing changes and rounds. Maintain strict adherence to patient confidentiality and privacy regulations, including HIPAA compliance, during all telehealth interactions and documentation processes. Submit orders for wound care products. Qualifications: Graduate of an accredited school of nursing required. Must possess current CPR certifications. Minimum of one (1) year of Wound Care experience required, (2) years preferred. Wound care certification is preferred. Must possess a current, unencumbered, active license to practice as a RN or LPN in state of practice. Excellent communication skills with the ability to convey medical information clearly to physicians, staff, patients and family Empathy, patience, and a genuine desire to provide quality healthcare services to patients at the bedside as well as through telehealth technology. Commitment to maintaining patient confidentiality, privacy, and data security in accordance with healthcare regulations (e.g., HIPAA). Ability to multitask, and adapt to changing telehealth workflows, job requirements, and patient populations. Prior experience in SNF, LTC, or Assisted Living preferred. Travel to assigned facilities using your personal car, valid driver's license, and mileage reimbursement offered. Role starts out Part-Time with the opportunity to be Full-Time.

Full-time Description The Utilization Review (UR) Nurse is responsible for analyzing medical records for medical-legal reviews and producing high-quality, professional executive summaries. These reports must follow client-specific and evidence-based guidelines, incorporating clear rationales for determining medical necessity. The role involves prospective, concurrent, and retrospective review of inpatient and outpatient treatment, certifying medical necessity, and recommending appropriate lengths of stay. Reports must be thorough, accurate, and tailored to the specific requirements of each case and client. Essential Job Functions: • Analyze and interpret clinical documentation for medical-legal reviews • Evaluate patient records to determine medical necessity and appropriateness of care using pre-approved guidelines (e.g., ODG, MTUS, InterQual, MCG) • Draft clear, concise, and professional executive summaries that: o Outline patient demographics and clinical course o Summarize and assess treatment plans and physician orders o Apply relevant evidence-based criteria o Provide clear rationale and recommendations • Ensure all reports are grammatically correct, free of spelling errors, and professionally formatted • Dictate and finalize report content using designated systems • Collaborate with physicians and clinical staff to clarify documentation or resolve discrepancies • Amend reports as new clinical information becomes available • Perform moderate research on a case-by-case basis to support findings • Participate in interdisciplinary teams to support high-quality patient care outcomes • Maintain a consistent caseload of 20 cases per day post-training • Achieve and maintain a Quality Assurance (QA) score of 97% or higher • Demonstrate consistent, reliable attendance and meet established deadlines • Perform additional duties as assigned Requirements Knowledge and Abilities Requirements: • In-depth understanding of anatomy, medical/surgical modalities, and imaging techniques • Strong knowledge of utilization review processes and criteria application • Excellent written communication skills, with a strong focus on grammar, spelling, clarity, and organization • Proven ability to analyze complex clinical information and apply critical thinking • Familiarity with medical necessity guidelines (ODG, MTUS, MCG, InterQual) • Ability to read and interpret clinical reports, technical documentation, and regulations • High proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) • Strong attention to detail and ability to meet high standards for accuracy • Effective time management and multitasking skills in a deadline-driven environment • Strong customer service orientation with the ability to communicate professionally with clients and providers • Ability to maintain confidentiality and demonstrate sound judgment • Ability to type a minimum of 45 WPM • Excellent verbal and written communication skills in English Qualifications: • Active, unrestricted Registered Nurse (RN) license required • Minimum of 2-3 years of relevant clinical experience required • Prior experience in workers compensation, utilization review, case management, or medical-legal review required License and Certification: Current RN licensure, without restrictions Driving Essential: No Position Demands: This position requires sitting, bending, and stooping for up to 8 hours per day in an office setting. Ability to lift and move objects weighing up to 10 lbs. Ability to learn technical material. The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc. Must be able to operate a computer and other office productivity machinery such as a calculator, copy machine, printer, etc. The person in this position frequently communicates with guests, team members, and vendors and must be able to exchange accurate information. Equal Employment Opportunity (Our EEO Statement): The Company is a veteran-owned Company and provides Equal Employment Opportunities (EEO) to all Team Members and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender (including gender identity), pregnancy, childbirth, or a medical condition related to pregnancy or childbirth, national origin, age, disability, genetic information, status as a covered veteran in accordance with applicable federal, state, and local laws, or any other characteristic or class protected by law and is committed to providing equal employment opportunities. The Company complies with applicable state and local laws governing non-discrimination in employment. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, promotion, discharge, pay, fringe benefits, membership, job training, classification, and other aspects of employment. Team Members who believe they are the victims of discrimination should immediately report the concern to their Supervisor and Human Resources Department. Discrimination and harassment will not be tolerated. We are committed to creating an inclusive environment for all Team Members and applicants. We value the unique skills and experiences that veterans bring to our team and encourage veterans to apply. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of our personnel. All company team members may be required to perform duties outside of their normal responsibilities from time to time, as needed.

* Review approximately 20 cases a day for medical necessity. * Advocate for and protect members from unnecessary hospital admissions. * Follow established procedures and processes to complete authorizations. * Collaborate with a team of nurses to assist each other and complete cases. Qualifications: * 3+ years of utilization management, concurrent review, prior authorization, utilization review, case management, and discharge planning is must * Active RN Compact License is Must If you are Interested , Kindly give a call : ************** Job Type & Location This is a Contract position based out of Fort Worth, TX. Pay and Benefits The pay range for this position is $35.00 - $40.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Jan 21, 2026. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.