- Texas Health Resources (Arlington, TX)
- Director Utilization Management-Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... will be ad hoc and required meetings onsite throughout the year. Summary The Director will be the department leader for system services for wholly owned and Partner… more
- Houston Behavioral Healthcare Hospital (Houston, TX)
- … Management Coordinator. The Utilization Management Coordinator will report to the Director of Utilization Review and will be responsible to provide ... quality case management services to all patients and their families, to serve as a member of interdisciplinary team supporting the organization's treatment program and philosophy, and assure the deliverance of quality treatment to patients and their families.… more
- Elevance Health (Wallingford, CT)
- …may be considered. The **Medical Director ** will be responsible for utilization review case management for North Carolina Medicaid. May be responsible ... ** Utilization Management Medical Director - NC Medicaid**...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- UCLA Health (Los Angeles, CA)
- Description Under the direction of the Assistant Director , the ICM Medicare Advantage Utilization Review Nurse performs utilization review of medical ... population enrolled under UCLA Medical Group. The ICM Medicare Advantage Utilization Review Nurse ensures that home health and durable medical equipment services… more
- BrightSpring Health Services (Sacramento, CA)
- …days of death and submit to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at least monthly to ensure ... are coordinated with behavioral and programmatic staff in partnership with the Executive Director . The Director of Nursing is accountable for overseeing the… more
- Commonwealth Care Alliance (Boston, MA)
- …The Manager, Utilization Management reports to the Director of Utilization Management * Oversees clinical decision review for services requiring prior ... Knowledge, Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization, concurrent and retrospective… more
- Elevance Health (Dearborn, MI)
- …Coast time zone hours.** The **Medical Director ** will be responsible for utilization review case management for Commercial business in the New England (CT, ... **Medical Director - Commercial** Location: This role enables associates to...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
- UPMC (Pittsburgh, PA)
- …Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , Utilization Management ... full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… more
- Tufts Medicine (Burlington, MA)
- …coordinates the design, development, implementation, and monitoring of the organization's utilization review functions. The position establishes the department's ... utilization of resources, coordination of care across the continuum and utilization review and management. The position develops and leads the Utilization … more
- UPMC (Pittsburgh, PA)
- The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
- Wellpath (Lemoyne, PA)
- …Medical Director of Utilization Management leads and oversees utilization review , case management, quality improvement, and related policy and practice ... efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management Team consisting… more
- AmeriHealth Caritas (Philadelphia, PA)
- … Management, provides organizational leadership in the operational areas of appeals, utilization review , quality improvement, and related policy and practice ... initiatives in collaboration with the Corporate Medical Directors, Utilization Management and the Vice President, Medical Affairs. ; **Work Arrangement:** + Remote… more
- Arms Acres (Carmel, NY)
- …life skills) as identified in patient treatment plans and requested by program director . Performs utilization review , provides progress reports and develop ... implementation of the multidisciplinary treatment plan; coordinates treatment plan review ; performs these activities within established time frames. Documents… 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 ... collaboration with the interdisciplinary team, the UMN handles tasks related to utilization review across various specialties, medical treatments, and services.… more
- Molina Healthcare (GA)
- …services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team ... of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work ... this position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include… more
- UTMB Health (Galveston, TX)
- Utilization Review Case Mgr - Galv. Campus Utilization Mgt (10hr shifts) **Galveston, Texas, United States** **New** Nursing & Care Management UTMB Health ... and criteria guidelines. **MAJOR DUTIES / CRITICAL TASKS:** + Implements Utilization review procedures by prospectively, concurrently, and retrospectively… more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart...tasks requested by the UR Manager, CEO or Medical Director to meet the needs of the Center. Perform… more
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