- LA Care Health Plan (Los Angeles, CA)
- Supervisor , Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... the safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day… more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: The Supervisor of Utilization Management has an important role in a high-profile group tasked with implementing system-wide improvements and ... operational processes to ensure optimal and compliant utilization review strategies. Under minimal supervision from the Manager the Supervisor is responsible for… more
- Dignity Health (Rancho Cordova, CA)
- …Summary:** Under the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable ... sets (Medicare Guidelines InterQual Health Plan Benefit Interpretation Guidelines and Medical Management Policies and DHMF Utilization Management guidelines… more
- AmeriHealth Caritas (LA)
- …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... and efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon to: + Conduct utilization … more
- AmeriHealth Caritas (Washington, DC)
- …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Rady Children's Hospital San Diego (San Diego, CA)
- JOB SUMMARY: Under the supervision of the Utilization Management (UM) Operations Supervisor , the UM Coordinator I's primary job function is to support UM ... operations by performing any non-clinical tasks. This includes, but is not limited to, initial authorization processing, (data entry, eligibility verification, benefits verification, and requesting required supporting documents from submitting provider… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print... Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 - $167,136.48 Annually Location Los… more
- Hackensack Meridian Health (Edison, NJ)
- …a leader of positive change. The role of ** Supervisor , Care Management ** integrates and coordinates utilization management , care coordination, discharge ... acute care setting. + Familiar with hospital resources, community resources, and/or resource/ utilization management . + Care coordination, case management or… more
- Spectrum Billing Solutions (Skokie, IL)
- …cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing team. The UR Supervisor ... and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for treatment… more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical ... and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role in ensuring CCA meets CMS… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role...requirements are met + Additional duties as requested by supervisor + Maintains knowledge of CMS, State and NCQA… more
- Helio Health Inc. (Syracuse, NY)
- …Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management ... track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our Inpatient,… more
- Mount Sinai Health System (New York, NY)
- …Excel and Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...EOW** To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring… more
- Mohawk Valley Health System (Utica, NY)
- RN Supervisor Case Management - Full Time - Days Department: CARE MANAGEMENT SERVICES Job Summary The Supervisor Case Management - SNH is responsible ... for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include the supervision and… more
- Ellis Medicine (Schenectady, NY)
- + The Supervisor of Case Management and Social Work (CMSW) assists with the daily operations of the Department. This person can assist with the hiring and ... of stay (LOS) and cost per case through resource management . + The Supervisor of CMSWS is...CMSWS assist with providing the link between compliance, clinical management , patient progression, gathering and reporting of utilization… more
- Novant Health (Wilmington, NC)
- Job Summary The Case Management Supervisor is responsible for day to day supervision, operations, monitoring ongoing quality, productivity, and efficiency for ... both Utilization Review and Case Management activities. Is available for staff guidance, direction, resource identification and problem resolution. Seeks… more
- Catholic Health Initiatives (Little Rock, AR)
- … management and utilization management **Overview** As a **Care Management Supervisor ** at CHI St Vincent, you'll oversee a department of care ... **Responsibilities** The Care Coordination Supervisor is responsible for the supervision of the...within 2 years upon hire Minimum 1 year care management / utilization management experience… more
- Molina Healthcare (Milwaukee, WI)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- State of Connecticut, Department of Administrative Services (Norwich, CT)
- …position located in Norwich, CT. The Case Management Supervisor oversees that requirements are ... Developmental Services Supervisor Of Case Management Hybrid Recruitment...team meetings to insure compliance with DDS policies and utilization of good team process skills; + Makes assessments… more
- AdventHealth (Shawnee, KS)
- …at our hospital in Shawnee Mission, Kansas. **The role you'll contribute:** The Care Management Supervisor is under the general leadership of the Care ... and performing the daily operations and supervision of team members in the Care Management department. The Care Management Supervisor is responsible for the… more