- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... who is willing and able to work in a hybrid model. The incumbent will be expected to work...medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care.… more
- Henry Ford Health System (Troy, MI)
- … to provide administrative, operational and organizational support for the Utilization Management teams. PRINCIPLE DUTIES AND RESPONSIBILITIES: + Researches, ... by NCQA and compliance with CMS and privacy policies. + Provides Utilization Management staff support and liaison support to committees, including research and… more
- Highmark Health (Sacramento, CA)
- …Proven ability to deliver engaging and informative product demonstrations and walkthroughs. + ** Utilization Management & Clinical Expertise:** + Utilization ... in PA, DE, WV or NY this is a hybrid role requiring 3 days in office** Note additional...Management Knowledge: A strong understanding of utilization management principles, processes, and industry best… more
- Ford Motor Company (Allen Park, MI)
- **Technician Utilization Manager ** We are the movers of the world and the makers of the future. We get up every day, roll up our sleeves and build a better world ... identify opportunities and implement solutions that drive tangible results? As our Technician Utilization Manager , you'll play a pivotal role in enhancing the… more
- Phoenix House (Wainscott, NY)
- ** Utilization Review Manager ** **Job Details** **Job Location** East Hampton Residential - Wainscott, NY **Position Type** Full Time **Education Level** Graduate ... Morning **Job Category** Nonprofit - Social Services **Description** **SUMMARY** The Utilization Review (UR) Manager coordinates commercial, and Medicaid Managed… more
- Providence (Anchorage, AK)
- …hire. + National Certification in area of specialty. + 1 year experience in care management or utilization review in any setting or successful completion of TIPS ... Inpatient setting. + IRR or annual competency testing in Utilization Review. **Preferred Qualifications:** + Bachelor's Degree in Nursing...program or Case Management Orientation Program. **Why Join Providence?** Our best-in-class benefits… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse!Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ... Working under the general supervision of the Director and/or Manager /Supervisor of Medical Management , and in collaboration...activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management … more
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... as a team member. **Qualifications** **Qualifications** **Required** + **One year** ** Utilization Review or Case Management experience.** **Licenses Required** +… more
- Elevance Health (Miami, FL)
- ** Utilization Management Representative II** **Location:** This role enables associates to work virtually full-time in **Florida** , with the exception of ... 6 am - 6 pm EST including weekends. The ** Utilization Management Representative II** is responsible for...to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by… more
- Elevance Health (Columbus, GA)
- ** Utilization Management Representative III** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... and ensures essential face-to-face onboarding and skill development. The ** Utilization Management Representative III** is responsible for coordinating… more
- Elevance Health (Latham, NY)
- ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... integration, and ensures essential face-to-face onboarding and skill development. The ** Utilization Management Representative II** is responsible for managing… more
- Elevance Health (San Antonio, TX)
- …and personalized support throughout the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior Authorization **Location:** ... immediate support. **Build the Possibilities. Make an extraordinary impact.** The ** Utilization Management Representative II - Prior Authorization** is… more
- Elevance Health (Louisville, KY)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... integration, and ensures essential face-to-face onboarding and skill development. The ** Utilization Management Representative I** will be responsible for… more
- Elevance Health (Columbus, GA)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... integration, and ensures essential face-to-face onboarding and skill development. The ** Utilization Management Representative I** will be responsible for… more
- AON (San Francisco, CA)
- …Nothing in this job description restricts management 's right to assign or reassign duties and responsibilities to this job at any time. #li- hybrid #li-mm ... an outstanding role for you! This role is a hybrid role based out of our San Francisco, CA...is different: + Collaborate with Account Specialist staff, Account Management team, and Client Service Delivery Leaders to establish… more
- Staples (Framingham, MA)
- …exceed P&L/budgets requirements + Optimize transportation spend through the strategic selection/ utilization of "best in class" carriers + Develop with support of ... of DOT mandated rules and regulations + Partner with Legal and Risk Management to address and mitigate business risk/ issues + Define project objectives, scope… more
- Cedars-Sinai (Los Angeles, CA)
- …by payor, line of business and physician for trends and anomalies. Works with Utilization Management and Medical Directors to ensure an adequate panel of ... network integrity, physician network performance, patient and provider experience, and utilization management the best standard processes (specialty cost). +… more
- Citigroup (Jersey City, NJ)
- …and drive strategy across our industry. **Team/Position Overview:** The Collateral Management team sits in Margin and Collateral function in Markets Operations. ... regulatory requirements, whilst delivering best-in-class capabilities in margin and collateral management , inventory management , risk management and… more
- RWJBarnabas Health (Somerset, NJ)
- Regulatory Planning Manager ( Hybrid ) - Somerset, NJReq #:0000170498 Category:Professional / Management Status:Full-Time Shift:Day Facility:RWJBarnabas Health ... - $129,204.00 per year Location: Somerset, Somerset, NJ 07052 Job Title: Manager Location: Barnabas Health Corp Department: External Affairs and Policy Req#:… more
- Tufts Medicine (Boston, MA)
- **_This Senior Project Manager role will support Tufts Clinical and Translational Science Institute (CTSI) initiatives to advance quality improvement, dissemination ... (D&I) science, and Learning Health System (LHS) practices. The Senior Project Manager will lead projects to improve research operations, foster the use of… more