- Carle Health (Champaign, IL)
- …processes. Strong human relations, influencer, leadership, teamwork, process management , interpersonal, and communication skills. Ability to facilitate diverse ... analyze and effectively present data related to quality and performance management activities Maintain a current understanding of the behavioral health rules,… more
- CVS Health (Springfield, IL)
- …in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds ... 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
- Integra Partners (Troy, MI)
- …of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, salaried role functions ... The Utilization Review Medical Director is responsible...or past OIG or state sanctions + Experience performing utilization management or clinical review activities +… more
- Healthfirst (NY)
- …maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** + ... closely with other Operations leaders including but not limited to Care Management , Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to… more
- Guthrie (Cortland, NY)
- …Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization /certification for ... Summary The LPN Utilization Management (UM) Reviewer, in collaboration...and other hospital departments as appropriate to obtain prior authorization required to meet contractual reimbursement requirements and to… more
- LA Care Health Plan (Los Angeles, CA)
- …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II...the discharge planning process, including providing clinical review and authorization for alternate levels of care, home health, durable… more
- Actalent (Sacramento, CA)
- …for the UM/QM Supervisor, Manager, and/or Director of Medical Management . Responsibilities + Coordinate and support authorization processing for outpatient, ... Job Title: Utilization Management Coordinator Job Description As...and prepare reports for the UM/QM Supervisor, Manager, and/or Director of Medical Management . Essential Skills +… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team ... action plans as needed. + Oversee case assignment, queue management , and authorization workflows to ensure timely...(eg, Provider Relations, Quality) to resolve escalations and address utilization management issues. + Represent UM nursing… more
- Intermountain Health (Las Vegas, NV)
- …of hire or promotion. + Demonstrated care management experience. + Authorization or Utilization Management experience. + Leadership experience. ... work and complex care planning, transitions of care, and utilization management . The position ensures compliance with...Care Management I reports to the Care Management Director . **Position Details** + Full Time… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... financial, and utilization goals through effective management , communication, and...progressive discipline process when appropriate * Collaborates with department director and professional development specialist to develop standard work… more
- Saint Francis Health System (Tulsa, OK)
- …not all inclusive nor does it prohibit the assignment of additional duties. Utilization Management - Laureate Campus Location: Tulsa, Oklahoma 74136 **EOE ... in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal… more
- Saint Francis Health System (Tulsa, OK)
- …placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the ... is not all inclusive nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location: Tulsa, Oklahoma 74136 **EOE… more
- Integra Partners (Troy, MI)
- … Director ) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES ... claims platform + Verify all necessary documentation has been submitted with authorization requests + Contact requesting providers to obtain medical records or other… more
- Community Health Systems (Franklin, TN)
- …preferred **Knowledge, Skills and Abilities** + Strong knowledge of utilization management principles, payer requirements, and healthcare regulations. ... Summary** The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals… more
- Integra Partners (Troy, MI)
- …experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key ... role in collaborating with our Medical Director to perform benefit and medical necessity reviews and...limited to: + Perform pre-service and post service UM authorization reviews utilizing federal and state mandates, plan benefit… more
- Community Health Systems (Naples, FL)
- …decisions regarding medical necessity and care status. + Proficient in utilization review processes, admission criteria, and payer authorization requirements. ... Join us as a **Registered Nurse (RN) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is an onsite… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... admissions and extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key contact for facility… more
- CVS Health (Trenton, NJ)
- …able to work an Eastern Standard Time schedule** **Must be a licensed RN** + Utilization Management is a 24/7 operation and the work schedule may include ... specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. **Required Qualifications** + Must have...RN License + 3+ years of clinical experience + Utilization Management is a 24/7 operation and… more
- Houston Methodist (Houston, TX)
- …oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for ... At Houston Methodist, the Sr Director Case Management position is responsible...needed. + Collaborates with HMCPA on care transition and utilization management initiatives. + Provides strategic vision… more
- Ventura County (Ventura, CA)
- …and communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality ... admissions, elective surgical procedures, referrals, tests, medication approvals requiring authorization .) + Develops utilization management standards… more
