- Providence (Seattle, WA)
- **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote . The role requires a broad knowledge and ... focus on Utilization Management and Denials principles such as...Direct responsibility and oversight for divisional pre-service and post-service utilization review, clinical claims audit, clinical… more
- Commonwealth Care Alliance (Boston, MA)
- …Certificate or active nursing license in good standing required + 3+ years combined clinical and utilization management experience required + 3+ years' ... **Why This Role is Important to Us:** The Nurse Utilization Management (UM) Reviewer is responsible for...Management (UM) Reviewer is responsible for day-to-day timely clinical and service authorization review for medical necessity and… more
- CVS Health (Sandy, UT)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in ... internal and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications - 3+ years of… more
- CVS Health (Frankfort, KY)
- …other internal and external constituents in the coordination and administration of the utilization /benefit management function. + Utilizes clinical skills to ... coordinate, document and communicate all aspects of the utilization /benefit management program. Required Qualifications : + Licensed independent Behavioral… more
- Commonwealth Care Alliance (Boston, MA)
- …management and leadership with the development, refinement and enhancement of utilization management workflows, policies and procedures. + Participate in ... reports to the UM Manager. The Team Leader provides management ,oversight and mentorship to team members and ensures that...review, workflow review and other relevant business related to utilization review process. + Works in collaboration with the… more
- Prime Therapeutics (Columbus, OH)
- …every decision we make. **Job Posting Title** Senior Project Solution Manager ( Utilization Management ) - Remote **Job Description Summary** Responsible ... and monitoring and summarizing progress of projects. Prepares reports for upper management regarding status of project. Familiar with a variety of the field's… more
- ProgenyHealth (Elk Grove Village, IL)
- ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns. Our program promotes appropriate utilization , ... and throughout the first year of life. Job Role Clinical care nurses coordinate overall member care, from pre-admission,...events throughout the year + Role specific - full remote work week ProgenyHealth positively recruits people from diverse… more
- Virtua Health (Pennsauken, NJ)
- …Locations: Job Information: Schedule: Monday - Friday 8:00am - 4:30. This is a remote position but would require going into the office in Pennsauken on an ... processes and maintains required documentation and reports such as productivity/ utilization , medical records, customer surveys, audits, financial reports, staff… more
- CVS Health (Raleigh, NC)
- …to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live ... membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical ...to coordinate, document and communicate all aspects of the utilization /benefit management program. -Utilizes clinical … more
- Centene Corporation (Austin, TX)
- …is a remote position. Ideal candidate will have experience in utilization management or prior authorization with leadership responsibilities in their current ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks… more
- Centene Corporation (Austin, TX)
- … Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...facilitates operations within utilization management . + Manages prior authorization, concurrent… more
- CVS Health (Columbus, OH)
- …care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is fully remote and employee can ... live in any state. As a Utilization Management Nurse Consultant, you will utilize clinical ...to coordinate, document and communicate all aspects of the utilization /benefit management program - Utilizes clinical… more
- CVS Health (Harrisburg, PA)
- …care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is fully remote and employee can ... expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical ...to coordinate, document and communicate all aspects of the utilization /benefit management program. - Utilizes clinical… more
- CVS Health (Harrisburg, PA)
- …care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate ... can live in Pennsylvania. As a Utilization Management Nurse Consultant, you will utilize clinical ...to coordinate, document and communicate all aspects of the utilization /benefit management program. - Utilizes clinical… more
- Humana (Columbus, OH)
- …of three years varied clinical nursing experience + Experience in utilization management + Ability to work independently under general instructions and ... community and help us put health first** The Compliance Utilization Management Nurse 2 reviews utilization...to troubleshoot and resolve basic technical difficulties in a remote environment **Preferred Qualifications** + BSN + 2 years… more
- Sanford Health (SD)
- …Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to ... utilization and potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality of care for… more
- Children's Mercy Kansas City (Kansas City, MO)
- …Responsibilities Personnel management : + Directs team members in the delivery of utilization management and care management services. + Promotes a ... professional development. + Partners with Revenue Cycle, Payor Relations, HIM and Risk Management in support of utilization management and high-risk… more
- CVS Health (Columbus, OH)
- …to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live ... internal and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + 3+ years of… more
- CVS Health (Tallahassee, FL)
- …- 3+ years of clinical experience - Managed Care experience - Utilization management experience Education Associates degree required BSN preferred Pay Range ... and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with… more
- CVS Health (Sacramento, CA)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications - 3 years of ... convenient and affordable. Position Summary This is a full-time, remote role. Looking for someone located in any state...a UM Clinician Behavioral Health you will: - Utilize clinical experience and skills in a collaborative process to… more