- BroadPath Healthcare Solutions (Tucson, AZ)
- …of Texas or compact license + 3+ years Nursing experience + 1+ years Utilization Management and Appeals experience + Excellent verbal, written and computer ... **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical… more
- Commonwealth Care Alliance (Boston, MA)
- … UM program and leads and organizes the ongoing evaluation of the utilization management program against quality and utilization benchmarks and ... performance monitoring and - Leads the Utilization Management team in managing and continuously improving UM... Management team in managing and continuously improving UM program design, policies, procedures, workflows, and… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …as part of a core team. You'll collaborate cross-functionally with care management , utilization management , provider/member relations, and market-facing ... Healthsource blog: https://healthsource.premera.com/ . The **Senior Clinical Pharmacist,** **Oncology Program ** will lead and help develop Premera's oncology … more
- Stony Brook University (Stony Brook, NY)
- …other projects as assigned. Identifies, follows and documents Avoidable delays in Care Management Program . Reviews and documents on patients who were readmitted ... **Duties of a RN Case Manager in the Care Management Department may include the following but are not...the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity… more
- ERP International (Tinker AFB, OK)
- …algorithms, CM software, and databases for community resources. - Integrate CM and utilization management ( UM ) and integrating nursing case management ... a professional and courteous way. - Participate in all phases of the Case Management Program (CMP) and ensure that the CMP meets established case management … more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- Salary: $65,000/year Position Summary: The UM Program Manager provides oversight and management of service authorization data validation, reporting and trend ... line-by-line entries, and submits to finance for payment. The UM Program Manager reconciles ARGOS Dependency Cases...application for daily entry of case activity and the utilization management of service authorizations. Educational and… more
- Veterans Affairs, Veterans Health Administration (Prescott, AZ)
- …evaluating and recommending appropriate levels of care and services using standardized criteria. The Utilization Management ( UM ) Program , a key component ... Care System is looking for a Registered Nurse - Utilization Management to join the Quality &...the clinical expertise and leadership of the medical center's UM Program . The UMC possesses knowledge of… more
- Veterans Affairs, Veterans Health Administration (Johnson City, TN)
- Summary The UM Nurse shares the responsibility for planning, implementation, and evaluation of both the clinical and administrative services aspects of its ... program . Communicates with physicians, nurses and other health care...Duties include: - Works with the medical center's Quality Management office to promote quality in the Medical Center… more
- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The UM ( Utilization Management ) Administration Coordinator 2 contributes to administration of ... utilization management . We focus on living out our values daily...eligible dependents Parental and caregiver leave Employee charity matching program Network Resource Groups (NRGs) Career development opportunities **Social… more
- Molina Healthcare (Syracuse, NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. **Required Qualifications** ... surgical, emergency room, intensive care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work Hours: Monday - Friday 8:00am-… more
- Molina Healthcare (Salt Lake City, UT)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours:...be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and… more
- Humana (Lansing, MI)
- …of our caring community and help us put health first** The Utilization Management Certified Occupational Therapy Assistant 1 ( UM COTA) uses skills to support ... ser vices and supports and/or benefit administration determinations. The UM COTA work assignments involve moderately complex to complex...facing and is part of Humana's Tuberculosis (TB) screening program . If selected for this role, you will be… more
- Molina Healthcare (San Francisco, CA)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. * Participates as needed in joint ... for LVN's with at least 2 years of experience with the following: UM , Prior Authorization, NCQA accreditation, and knowledge of InterQual / MCG guidelines. Excellent… more
- CenterWell (Annapolis, MD)
- …**Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization review ... work, communication of decisions to internal associates, participation in care management and possible participation in care facilitation with hospitals. The… more
- Centers Plan for Healthy Living (Margate, FL)
- …with the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to ... the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists… more
- UNC Health Care (Morrisville, NC)
- …of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a strategic and operational leader ... information systems (ISD) to create a unified and standardized utilization management ( UM ) infrastructure. This...that impact the success of the organization and the UM program . 2. **Leading People** - Operational… more
- LA Care Health Plan (Los Angeles, CA)
- …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 ... Supervisor, Utilization Management RN Job Category: Clinical...department's performance measures outcomes and goals. Plans and oversees UM activities according to model of care, program… more
- Dignity Health (Bakersfield, CA)
- …remote, but will be expected to work PST business hours.** **Position Summary:** The Utilization Management ( UM ) Trainer (Technical and Systems Focus) will ... authorization details and clinical data. 3. Documentation and Platform Utilization : - Train UM staff on the...**Minimum Qualifications:** - Minimum of 5 years experience in Utilization Management or related managed care functions.… more
- Guthrie (Sayre, PA)
- …To $25,000 Sign On Bonus For Qualified RNs! Summary The Registered Nurse (RN) Utilization Management ( UM ) in collaboration with Care Coordination, Guthrie ... . This role is responsible for ensuring that the UM program maintains documented, up-to-date policies and...coding, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer… more
- Commonwealth Care Alliance (Boston, MA)
- … UM program and leads and organizes the ongoing evaluation of the utilization management program against quality and utilization benchmarks and ... performance monitoring and * Leads the Utilization Management team in managing and continuously improving UM... Management team in managing and continuously improving UM program design, policies, procedures, workflows, and… more
