- Amherst College (Amherst, MA)
- …and policies. Decisions and actions are regularly reviewed by the supervisor for approval or redirection.Summary of Duties and ResponsibilitiesOffice Support: ... requests in a timely manner. Administratively supports the selection, training, and utilization of the Community Standards Review Board. Enters case information and… more
- State of Minnesota (Vadnais Heights, MN)
- **Working Title: Utilization Management Supervisor ** **Job Class: State Program Administrator, Director** **Agency: Direct Care and Treatment** + **Job ID** ... our DCT Quality Team for an exciting and rewarding opportunity as a Utilization Management Supervisor ! This position will work across DCT in partnership with… 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 ... internal partners (eg, Provider Relations, Quality) to resolve escalations and address utilization management issues. + Represent UM nursing team in internal… more
- 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
- Centene Corporation (Sacramento, CA)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Coordinator Supervisor oversees the day-to-day operations and performance of the UM Coordinator team. This position ensures ... required; bachelor's degree preferred. + minimum of 2 years of experience in Utilization Management (UM), managed care, or healthcare operations, preferably in a… more
- Molina Healthcare (San Francisco, CA)
- …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
- 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
- Martin's Point Health Care (Portland, ME)
- …Summary The Supervisor is responsible for day-to-day operations of the utilization review team, which includes clinical and non-clinical staff, in the areas of ... years of medical management experience in a managed care setting including utilization review + RN experience in a clinical setting required + Leadership and/or … 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
- Ventura County (Ventura, CA)
- Senior Registered Nurse - Hospital Management Utilization Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5061650) Apply Senior Registered ... Nurse - Hospital Management Utilization Salary $118,668.43 - $141,888.74 Annually...+ Preceptor Pay - $2.50 per hour + House Supervisor Pay - $4.00 per hour + Charge Nurse… 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
- 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
- Actalent (Fort Lauderdale, FL)
- … Utilization Review Nurse Job Description We are seeking a dedicated Utilization Management Nurse (UMN) who will work collaboratively with an ... Prepare and present reports on department activities as assigned. Essential Skills + Utilization management + Behavioral Health + Mental Health + Clinical review… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests for ... reports on department activities as assigned. Essential Skills + Experience in utilization management , behavioral health, and mental health. + Proficiency in… more
- Catholic Health Services (Melville, NY)
- …Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and appeals functions to include coordination of ... payment related activities. Position Responsibilities: + Prepares necessary documentation for utilization management and appeals processes, performs data … more
- Saint Francis Health System (Tulsa, OK)
- …in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal ... Reviews eligibility and benefits of patients, matching the level of care utilization . Assures compliance with Managed Care Behavioral Health standards in the area… 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
- Ascension Health (Baltimore, MD)
- …time of hire. **Additional Preferences** + One year of **recent** experience in Utilization Management required. + Local and national travel options are ... for resources and removal of barriers. + Maintain ongoing dialog with supervisor and other health providers to ensure effective implementation of health plan.… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions as the ... necessity of outpatient observation and inpatient stays and the utilization of ancillary services + Perform other duties as...services + Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials.… more
