- 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
- Luke Staffing (Yigo, GU)
- …co-workers, families, peers, and other health team members. + Submits all concerns through Utilization Management Director ; be able to identify, analyze, and ... experience is required. One year of previous experience in Utilization Management is required. Full time employment...and unrestricted license to practice as a Practical OR Registered Nurse in any one of the… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …defined as 4 years of professional work experience in a corporate environment\. + **Licensure:** Registered Nurse \( RN \) with active license in the state of ... + 5 years - progressive leadership experience in care management , utilization management , clinical operations,...+ Analytical: Strong business acumen with sound analytical skills Registered Nurse with BSN highly preferred\. Managed… more
- Alameda Health System (Oakland, CA)
- …or related fields. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State ofCalifornia RequiredExperience:Seven years of ... Director , Service Line Administration + Oakland, CA + Highland...MCH/OB Clinic (K6) + Full Time - Day + Management + $85.55 - $142.40/ Hour + Req #:42908-31868 +… more
- Commonwealth Care Alliance (Boston, MA)
- 021350 Clin Alli-Care Delivery Administration Position Summary: The Director , Behavioral Health Care Delivery is responsible for the strategy and leadership of CCA's ... outreach workers in all CCA Care Delivery programs with BH components.The Director will collaborate closely with the Care Delivery Leadership to oversee, develop… more
- Commonwealth Care Alliance (Boston, MA)
- …and provider relationship management tools. - Understanding of claims operations, utilization management , and quality programs as they relate to provider ... contracting, or network operations, including 3-5 years in a director or senior management role. - Experience...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- 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
- Stanford Health Care (Palo Alto, CA)
- …Lead APP also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or the ... operational, and administrative initiatives of the service line Medical Director and unit nursing management team. ....under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse… more
- Stanford Health Care (Palo Alto, CA)
- …their APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or ... a licensed advanced practice provider: (Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered Nurse Anesthetist). +… more
- Stanford Health Care (Pleasanton, CA)
- …Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered Nurse Anesthetist) + Management experience Preferred **Required ... of Stanford Hospital and Clinics. In collaboration with the Director of Advanced Practice, the APP manager will participate...+ PA - Physician Assistant State Licensure or + RN - Registered Nurse -… more
- Commonwealth Care Alliance (Springfield, MA)
- …Work collaboratively with internal departments-including Clinical Operations, Contracting, Network Management , Utilization Management , and Business ... improvement. The LTSS Program Manager reports to the Senior Director of Delegation Partnerships and Provider Engagement. The Provider...& Language (nice to have):** + Familiarity with care management and utilization management systems… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... quality care. The BH Provider Engagement Program Manager reports to the Director of Delegation Partnerships and Provider Engagement. Supervision Exercised: - No,… more
- Commonwealth Care Alliance (Boston, MA)
- …compliance. The Senior Business Analyst, Clinical Operations reports to the Director , Clinical Operations Support. This role will provide significant BA support ... and presents results. + Develops and analyzes quantitative reports to assess utilization , productivity and adherence to policies and procedures related to various… 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...background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.… 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
- Centene Corporation (Sacramento, CA)
- …Expert knowledge of industry regulations, policies, and standards preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... experience with prior auth is highly preferred** **Position Purpose:** Directs the utilization management team to ensure the appropriate application of policy… 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 ... outcomes and reducing readmissions. #LI-CC2 Qualifications Required qualifications: 1. CA Registered Nurse 2. Bachelor's of Science in Nursing3. Grandfathered… more
- Bassett Healthcare (Cooperstown, NY)
- …of experience in Case Management , discharge planning, and/or Utilization Management Licensure/Certifications: + Registered Nurse or LMSW or eligible ... resources for the department. Oversees and works with the Director of Utilization Management to...well as state and federal regulations.* Collaboration: Partner with nurse managers, nursing directors, and other leaders across the… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
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