- Apex Health Solutions (Houston, TX)
- Job Title: Coordinator, Utilization Management Department: Medical Management Supervisor: UM Supervisor/ Manager , Medical Management The ... input service requests for a review determination by the UM Reviewer, Medical Management Manager ...Assistance or similar associates degree preferred Previous experience in utilization management or healthcare operational or a… more
- Sharp HealthCare (San Diego, CA)
- …the System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager ( UM ) partners with the Centralized Patient Placement ... and orientees under the direction of the ICM Centralized UM Leadership team. This position supports the 24/7 System...Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager… more
- Apex Health Solutions (Houston, TX)
- … Management Supervisor (s): UM Supervisor or Manager of Medical Management Summary Utilization Management ( UM ) Analyst represents the company ... leadership in ensuring regulatory compliance, accuracy, and consistency of UM processes. The Utilization Management ...input service requests for a review determination by the UM Reviewer, Medical Management Manager … more
- Ventura County (Ventura, CA)
- …full-time vacancies.) There are currently four (4) Regular full-time vacancies. One (1) within Utilization Management ( UM ), one (1) within Case Management ... Medical Management Nurse Senior- UM , CM/DM, &/or QA...that they will provide Care/Case management , Disease Management , Wellness and Prevention, Utilization Management… more
- YesCare Corp (Brentwood, TN)
- …and document any issues relating to the outpatient/inpatient UM process to the Manager of Utilization Management . + Assist with the data collection and ... + Experience Level: 3 - 5 year's experience in utilization management , case management , quality...development, implementation, evaluation and reporting. + Work with other UM inpatient and outpatient nurse reviewers to assure proper… more
- Fallon Health (Worcester, MA)
- …a Registered Nurse in a clinical setting required. + 2 years' experience as a Utilization Management nurse in a managed care payer preferred. + One year ... by the Manager + Refers high-risk cases to the Case Management Department, Government Services Clinical Programs, Fallon Clinic Care Coordination + Department… more
- LifePoint Health (Las Cruces, NM)
- …utilizes hospital resources in the development of care, discharge planning and Utilization Review. * Utilization Management performs prospective, admissions, ... observation and concurrent review according to standard policies and procedure. * Utilization Management reviews and analyze processes designed to ensure… more
- Elevance Health (Indianapolis, IN)
- … clinical operations business inside a health plan or a UM /benefits management firm - Utilization management or clinical experience with post-acute care, ... employment. **Director of Medical Mgmt - Home Health, DME UM ** + Job Family: MED > Licensed Nurse +...clinical reviews for a set of Post Acute Care Utilization Management solutions such as home health,… more
- Elevance Health (Columbus, OH)
- …being performed. Preferred: -Leadership experience managing teams of physicians in a utilization management clinical operations business inside a health plan or ... determination reviews for our Musculoskeletal (MSK) Solution. (internal title: Manager Clinical Operations Medical Director) Responsible for providing day-to-day...a UM /benefits … more
- Elevance Health (Atlanta, GA)
- …a check, or ask you for payment as part of consideration for employment. ** UM Medical Director - Cardiology** + Job Family: MED > Licensed Physician/Doctor/Dentist + ... to Medical Director Associates. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical program and/or independently… more
- Sharp HealthCare (San Diego, CA)
- …position, and employer business practices. **What You Will Do** To provide comprehensive utilization management and coordination of care for members who are ... contracted health plan requirements for documentation of concurrent SNF review and utilization management activities performed in a manner consistent with… more
- Universal Health Services (Riverside, CA)
- …and utilization of services as it relates to Quality Management programs. Oversight of HMO referrals pre-certification and retroactive reviews, delegation ... is the best place to work, practice medicine, and receive care. SUMMARY: Manager with a health care system development and integration for the organization will… more
- Corewell Health (Southfield, MI)
- …to the Clinical UM Supervisor's role is to assist the regional Clinical Utilization Management Manager with implementing operational changes and serve as ... we are Corewell Health. Scope of work The Clinical Utilization Management ( UM ) Supervisor is...work remotely and report directly to the regional Clinical Utilization Management Manager . + Responsible… more
- LA Care Health Plan (Los Angeles, CA)
- …the safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day ... Supervisor, Utilization Management RN (Outpatient) Job Category:...LA Care's culturally diverse membership. The position supports the UM Manager /Director. This role also assists … more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management ( UM ) Director is responsible for the ... market(s) development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the CommonSpirit Health Care… more
- Centene Corporation (Sacramento, CA)
- … activities, operations, costs, and forecasted data to identify areas for improvement within utilization management ( UM ) to align to goals and objectives + ... Review team to ensure appropriate care to members. Manages utilization management issues related to member care,...team, members, and providers + Works with the senior management team to develop and implement UM … more
- Dignity Health (Rancho Cordova, CA)
- …home.** **Position Summary:** Under the guidance and supervision of the department Manager /Director, the Supervisor of Utilization Management is responsible ... Five or more (5+) year's clinical experience required. - Three to five (3-5) years Utilization Management ( UM ) experience required. - One to three (1-3)… more
- UCLA Health (Los Angeles, CA)
- …the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management ... to plan, execute, and manage various initiatives related to UM administrative, operational, and strategic objectives. You'll demonstrate leadership...(BSN) degree required * Five or more years of utilization management required * Four or more… more
- LA Care Health Plan (Los Angeles, CA)
- …and to support the safety net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II is primarily responsible ... level of care (inpatient vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II...and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case ... Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US,...UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare, and… more