- 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 (Phoenix, AZ)
- … utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines + Monitors ... for this remote position.** **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and… more
- AmeriHealth Caritas (Dover, 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
- Amity Foundation (Tucson, AZ)
- …building. Remembrance, Resolution, Reconciliation, Restoration, Renewal Job Summary: As the Utilization Review Specialist, you will contribute to the ... individual is responsible for performing a variety of concurrent and retrospective utilization management -related reviews and functions and for ensuring that… more
- St Joseph's Addiction Treatment & Recovery Centers (Saranac Lake, NY)
- …Centers Location: Inpatient Facility - Saranac Lake, NY Position: Full-time Utilization Review Specialist Shift/schedule: Monday-Friday, 8:00am-4:30pm Pay Range: ... , supporting the agency's mission and client care quality. Department Utilization Review Employment Type Full-Time Minimum Experience Mid-level Compensation… 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
- Stanford Health Care (Palo Alto, CA)
- …- 5+ years of experience as an RN - 3+ years of experience in case management / utilization review Why work at Stanford Medicine | Stanford Health Care (SHC)? ... on a rotating basis with other managers when on-call Supervisor is unavailable. + Develops and oversees relationships and...+ Knowledge of principles and best practices of case management , utilization review , social work,… more
- Catholic Health Services (Melville, NY)
- …ensure timely follow through. | Reviews providers' requests for services and coordinates utilization /appeals management review . | Assist Utilization and ... Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and appeals functions to include coordination of… 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
- AmeriHealth Caritas (Charleston, SC)
- …about us at www.amerihealthcaritas.com . **Responsibilities:** Under the direction of the Supervisor , the Behavioral Health Utilization Management Reviewer ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer's discretion...of behavioral health and substance use disorder experience.; + Utilization management experience in a managed care… more
- Providence (Anaheim, CA)
- **Description** Under the direction of the Utilization Supervisor / Manager, this position is responsible for the distribution, review , accurate and timely ... Assistant Certification (CMA) upon hire. + 1 year of experience in utilization management or case management with experience in medical terminology and… 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
- McLaren Health Care (Flint, MI)
- …the Plan role will be supporting. + Two (2) years' experience in a managed care/HMO utilization review and/or case management role. + Available to work a ... We are looking for a Supervisor , Medical Management Registered Nurse, to...decision making. The primary focus for daily responsibilities includes utilization and case management process review… more
- Cedars-Sinai (Beverly Hills, CA)
- …Two (2) years of acute nursing, discharge planning and HMO, previous case management experience, utilization review , and knowledge of medical/nursing ... More About What You Will be Doing** The RN Supervisor Case Management will assist in the...and customer service. + Develops policies and procedures for Utilization /Referrals department under the mentorship of the Manager. +… more
- AdventHealth (Orlando, FL)
- …32,000 inpatients and 125,000 outpatients each year **The role you'll contribute:** **The Care Management Supervisor is under the general leadership of the Care ... and performing the daily operations and supervision of team members in the Care Management department.** **The Care Management Supervisor is responsible for… more
- Ochsner Health (New Orleans, LA)
- …the case managers and social workers responsible for patient care coordination, utilization review , intake and discharge planning. + Utilizes all available ... Certified Social Worker (LCSW). **Work Experience** **Required** - 3 years of utilization and/or case management experience with a registered nurse license… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Care Management Supervisor supervises, directs and coordinates the activities of Inpatient Management Clinical ... (MCG) to act as a resource to conduct concurrent review for medical necessity and appropriate level of care...and/or Compact State Licensure. **Experience:** 5 years experience in Utilization Management or Case Management … more
- HCA Healthcare (Asheville, NC)
- …of formulary agent, as well as, education to clinicians and patients regarding medication management . The pharmacist supervisor will be an active member of one ... satisfaction and personal growth, we encourage you to apply for our Supervisor Pharmacy Medication Reconciliation opening. We promptly review all applications.… more
- Louisiana Department of State Civil Service (Reserve, LA)
- …as, Nursing Policy and Procedure Committee, patient safety, quality assurance, and utilization review . Supervises the ordering of medical supplies and materials ... REGISTERED NURSE SUPERVISOR B Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4922155) Apply REGISTERED NURSE SUPERVISOR B Salary… more
- Mitsubishi Chemical Group (Mesa, AZ)
- …Accountabilities + Management of a Team: As the Operations Planning Supervisor you will lead a team of Production Control Coordinators to ensure seamless ... **Operations Planning Supervisor (1949)** + Title:Operations Planning Supervisor ...to ensure dates and planning is appropriate. + Resource Management : Coordinate with production managers to allocate resources effectively,… more
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