- 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
- Commonwealth Care Alliance (Boston, MA)
- …as the lead for CCA's Utilization Review functions working closely with other medical management team members. + Support the development of utilization ... for providing leadership and subject matter expertise to our utilization management (UM) group. This role is...licensed to practice in MA. + Board-certified in their medical specialty , required. + Must be clear… more
- Aspen Medical (Aurora, CO)
- JOB AD: Registered Nurse- Utilization Management Introduction : Aspen Medical has an exciting opportunity for Registered Nurses to partner with us in ... Case Management through the American Nurses Credentialing Center or Utilization Management Accreditation through National Committee for Quality Assurance… more
- Intermountain Health (Las Vegas, NV)
- …, care management , claims, network management , and finance. As the Medical Director for Utilization Management , you are responsible, in partnership ... contributions toward quality improvement efforts. Serves as the chair of Quality Medical Management Committee (QMMC) and other designated committees defined by… more
- Ochsner Health (New Orleans, LA)
- …high quality, cost-effective, efficient patient care services + Utilization Management experience (preferred) + Familiarity with: Current medical literature, ... Utilization Review Physicians (ABQAURP) or (3) Physician Advisor Sub- Specialty Certification by the American Board of Quality Assurance...utilization of resources + Assist with the denial management process + Review medical records of… more
- AmeriHealth Caritas (Newtown Square, PA)
- …services. Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director, Utilization Management provides organizational ... and related policy and practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President,… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours a week. + **Hospital:** Ascension Saint Thomas + **Location:** ... TN market. We're looking for an experienced Director of Utilization Management to join our team! In...consisting of a network of hospitals, affiliated joint ventures, medical practices, clinics and specialty facilities. Ascension… more
- Banner Health (AZ)
- …reducing costs. POSITION SUMMARY This position, within the Utilization Management Department, will determine the medical appropriateness of requested ... benefits, better opportunities and a better community. As a **Registered Nurse RN Utilization Management Care Reviewer,** you will be working in partnership with… 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
- AmeriHealth Caritas (Washington, DC)
- …**Responsibilities:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and ... most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health... will also be counted upon to: + Conduct utilization management reviews by assessing medical… more
- CVS Health (Frankfort, KY)
- …heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better Health of ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the quality, appropriateness, safety and cost of medications for our members through the medical management of drugs across our pharmacy and medical ... Managed care experience is strongly preferred, especially experience in utilization management . In lieu of managed care...accountable for a specific area of business, such as specialty drugs, Medicare drug, rebate management , audit… more
- CVS Health (Hartford, CT)
- …in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones. ... and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- Covenant Health Inc. (Knoxville, TN)
- …Position Summary: The RN Utilization Management I will perform utilization management functions to include medical necessity reviews to promote ... physician advisors and facility departments as related to utilization management . Communicates with hospital and payor medical directors in order… more
- Mount Sinai Health System (New York, NY)
- …and efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management , care facilitation and ... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West...on strategies to reduce denials. Works collaboratively with the Medical Center's Appeals Management Program 12. Presents… more
- Guthrie (Binghamton, NY)
- …necessary. Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations The pay range for this ... Provides health care services regarding admissions, case management , discharge planning and utilization review....specialties through a regional office network providing primary and specialty care in 22 communities. Guthrie Medical … 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 ... need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Catholic Health Services (Melville, NY)
- …queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, ... Science in Nursing or Health preferred. Minimum 5+ years of relevant clinical medical -surgical or specialty experience required as applicable to position needs.… more
- HonorHealth (AZ)
- …metropolitan area. The comprehensive network encompasses nine acute-care hospitals, an extensive medical group with primary, specialty and urgent care services, ... Facilitates the delivery of services to patients and families through effective utilization of available resources. Performs medical record reviews, as required… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management /clinical/or combination; 2 of 4 years ... prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. +… more