- 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 the ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 - $167,136.48… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing team. The UR ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Centene Corporation (Jefferson City, MO)
- … 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
- Centene Corporation (Tallahassee, FL)
- … utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines + Monitors ... **We're looking for two remote Supervisors of Behavioral Health Utilization Management to support our Florida market....you'll provide guidance and oversight to a team of Utilization Review Clinicians focused on behavioral health… more
- AmeriHealth Caritas (Newark, DE)
- …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
- Actalent (Sunrise, FL)
- …activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines ... Working under the general supervision of the Director and/or Manager/ Supervisor of Medical Management , and in collaboration...+ Valid Florida Driver's License. + Knowledge of case management and utilization review concepts,… 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
- AmeriHealth Caritas (Philadelphia, PA)
- …pediatric patients in a clinical setting + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization + Experience ... **Role Overview** Under the direction of the unit Supervisor , the Clinical Care Reviewer- Shift Care is...is presented to the Medical Director for medical necessity review . Upon approval of services, responsibilities include timely notification… 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
- Commonwealth Care Alliance (Boston, MA)
- …and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM)… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …encourage you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and ... and Appeals requests. + Assist with all Blue Card Claims escalations. + Assist management with the review and creation of desk level procedures, acting as… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- AdventHealth (Shawnee, KS)
- …at our hospital in Shawnee Mission, Kansas. **The role youll contribute:** The Care Management Supervisor is under the general leadership of the Care ... operations and supervision of team members in the Care Management department. The Care Management Supervisor...as needed + Participates in hospital/medical staff meetings to review patients meeting criteria related to high dollar/ extended… more
- AdventHealth (Orlando, FL)
- …**Location:** 7727 LAKE UNDERHILL ROAD, Orlando, 32822 **The role youll contribute:** The Care Management Supervisor is under the general leadership of the Care ... operations and supervision of team members in the Care Management department. The Care Management Supervisor...as needed. + Participates in hospital/medical staff meetings to review patients meeting criteria related to high dollar/ extended… more
- Dignity Health (Rancho Cordova, CA)
- …working knowledge of Utilization Management Working knowledge of the Utilization Management review processes, and regulatory requirements. Must have ... the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is...experience required in health plan/UM operations, Acute or subacute utilization review . - Graduate of an accredited… more
- Kaleida Health (Williamsville, NY)
- …Office Suite and Outlook. 2 years of experience In any combination of: case management , home care and utilization review preferred. Knowledge of and ... **Patient Management Supervisor ** **Location:** Millard Fillmore Suburban **Location of Job** : US:NY:Williamsville **Work Type** : Part-Time **Shift 1** **Job… more
- FirstEnergy (NJ)
- … Management Processes. + Participating in contractor evaluations, project review meetings and Lessons Learned meetings. + Lead department continuous improvement ... with FirstEnergy Service Co., a subsidiary of FirstEnergy Corp. [FEU] This Supervisor of Transmission Construction position is responsible for the administration and… more
- Ellis Medicine (Schenectady, NY)
- …Committee reports, functions and minutes. + Responsible for ensuring best practices of Utilization Review , Case Management , & Social Work Services following ... Supervisor is responsible for supervising the Case Management & Social Work Services staff. One must possess...a minimum of 2-3 years leadership experience in Case Management , Utilization Management and/or Quality… more
- ChenMed (North Miami Beach, FL)
- …license required if available in state. + A minimum of 2 years' onsite case management at ChenMed and/or utilization review or discharge planning in a ... we need great people to join our team. The Supervisor , Intensive Community Care, RN is a multi-market leadership...serve as coach, mentor/trainer to all members of care management team, giving guidance in best practices, troubleshooting to… more
- Ricoh Americas Corporation (Atlanta, GA)
- ** Supervisor I, Service Delivery** **POSITION PROFILE** Supervisor I, Service Delivery is the primary contact for managed document services at a customer ... and meeting profit objectives for each site within their territory. The Supervisor manages the delivery of Ricoh Enterprise Services for customers, which may… more
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