- Conifer Revenue Cycle Solutions (Detroit, MI)
- …process quality and accuracy adherence to process standards Relative cost management metrics goals expense, cost, and margin control monthly, quarterly, and ... annual financial goal management ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others...of hospital budgets and ensures and manages human resource utilization at all levels. Analyzes monthly P & L's… more
- University of New Mexico - Hospitals (Rio Rancho, NM)
- …promote and facilitate communication, problem solving, decision-making, crisis intervention, resource utilization , and conflict management * PATIENT SAFETY - ... delivery of optimal and safe patient care which includes fiscal management , standards compliance, clinical practice, staff development, oversight and active… more
- UNC Health Care (Morrisville, NC)
- …and well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and ... operational leader responsible for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds...or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental… more
- Commonwealth Care Alliance (Boston, MA)
- … Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management … more
- Prime Healthcare (Inglewood, CA)
- …Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients ... ie full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management… more
- Elevance Health (Durham, NC)
- ** Utilization Management Medical Director - NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required ... may be considered. The **Medical Director ** will be responsible for utilization review case management for North Carolina Medicaid. May be responsible… more
- Integra Partners (Troy, MI)
- … (Senior MD) serves as the clinical and strategic leader for Integra's Utilization Management (UM) and Credentialing programs. This is a full-time, 40+ ... quality and inter-rater reliability, overseeing audit readiness, and chairing Integra's Utilization Management Committee and Credentialing Committee. This role… 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials … 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 ... Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or CM. Knowledge of Department of Health Care Services… more
- AmeriHealth Caritas (Lafayette, LA)
- **Role Overview** Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services, ... making determinations based on clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of services,… more
- Trinity Health (Columbus, OH)
- …and task forces according to the UM Program and at the direction of the Director , Utilization Management . + Coordinates with the utilization review, ... technology, financial analysis, audit, provider relations and more. **Position Purpose** RN Utilization Management MCHP is responsible for the coordination of… more
- Intermountain Health (Las Vegas, NV)
- …work and complex care planning, transitions of care, and utilization management . The position ensures compliance with state, national , and regulatory ... Care Management I reports to the Care Management Director . **Position Details** + Full Time...Demonstrated care management experience. + Authorization or Utilization Management experience. + Leadership experience. **Preferred… more
- Actalent (Sacramento, CA)
- Job Title: Utilization Management Coordinator Job Description As a Utilization Management Coordinator, you will coordinate and support activities related ... Your role will involve compiling daily inpatient logs, reviewing specified utilization management reports, processing referrals, completing denial letters, and… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit ... review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working remotely. Primary Responsibilities *… more
- Brighton Health Plan Solutions, LLC (NC)
- About The Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit ... review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working remotely. Primary Responsibilities *… more
- Ascension Health (Austin, TX)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday, Days + **Location:** Remote + **Pay:** $93,857 - $126,983 + Eligible for ... + Two years of related experience is required. **Additional Preferences** + Utilization management experience strongly preferred. **Why Join Our Team** Ascension… more
