- Universal Health Services (San Antonio, TX)
- Responsibilities Position Summary : The Utilization Management Supervisor is responsible for planning, organizing, and managing daily operations of the ... Utilization Management team. The Supervisor duties include but are not limited to ensuring positive communication amongst treatment team members, modeling… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor , Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... 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… more
- Dignity Health (Rancho Cordova, CA)
- …Summary:** Under the guidance and supervision of the department Manager/Director, the Supervisor of Utilization Management is responsible and accountable ... (Medicare Guidelines, InterQual, Health Plan Benefit Interpretation Guidelines and Medical Management Policies, and DHMF Utilization Management guidelines… more
- UCLA Health (Los Angeles, CA)
- …Advantage team, you will be responsible for assisting with the day-to-day management of the UM department and coordinators. This will involve coordinating staff ... schedules to efficiently handle incoming referrals and phone call volume. You will develop workflows, desktop procedures, forms, training materials, and protocols for achieving team objectives and key performance indicators. You will hire and train… more
- WelbeHealth (Los Angeles, CA)
- …compliant, and cost-effective care to our participants. By guiding this team, the Utilization Management RN Supervisor drives the continuous improvement of ... a critical role in our participant's journey and our Utilization Management team ensures we can provide...external), clinical staff, and others to timely resolve any utilization management issues **Job Requirements:** + Minimum… more
- MetroHealth (Cleveland, OH)
- …specifically focusing on payer verification, preadmission processing, authorization, clincial utilization management functions, etc.). Works with the manager ... agreements. Serves as a clinical resource to the physician group and Utilization Management Specialists. Upholds the mission, vision, values, and customer… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …requests for specific services. Under the supervision of the Health Service Supervisor , the Utilization Management Representative is primarily responsible ... **Responsibilities** The Utilization Management Representative (UMR) provides office support for all units within the Utilization Management and/or… more
- Pacific Medical Centers (Seattle, WA)
- …USFHP Medical Director(s) to develop and implement strategic case management and utilization management yearly goals. The Supervisor Care Management ... **Description** The Supervisor Care Management RN is responsible for the supervision of case management (CM) and utilization management (UM)… more
- Hackensack Meridian Health (Hackensack, NJ)
- …standards, and regulatory/payor requirements. The role integrates and coordinates utilization management , care coordination, discharge planning functions and ... performance improvement activities for the case managers. The Supervisor Case Management is accountable for the...needs, manage the length of stay, and promote efficient utilization of resources; specific functions within this role include:… more
- Universal Health Services (Shippensburg, PA)
- Responsibilities Clininical Supervisor - Social Work/ Utilization Management Roxbury is currently hiring a Clinical Supervisor to oversee the clinical ... Insurance If you would like to learn more about the Supervisor , Social Work/ Utilization Management position before applying, please contact Terri Pendleton,… more
- Hartford HealthCare (Wethersfield, CT)
- …Resource Management Associate's focus is on providing support and coordination of utilization management services for the utilization management ... department. *_Position Responsibilities:_* 1. Monitors and manages assigned utilization management reports, including the Payer End of Day report, Utilization… more
- Intermountain Health (Las Vegas, NV)
- …health plan criteria, MCG criteria, and state, local, or federal guidelines relating to utilization management . + Demonstrated knowledge of case management , ... work experience related to inpatient management , case management , utilization management , quality ...been included. Other duties may be assigned by the supervisor . All positions subject to close without notice. Thanks… more
- Providence (Everett, WA)
- **Description** ** Utilization Management Assistant (279237)** **Schedule: FTE 1.0, Monday-Friday 08:00AM - 4:30PM PST (8HR SHIFT), Day** The primary ... responsibility of the position is to maintain standard compliance and performance related utilization management data. Process of daily, weekly and monthly UM… more
- Billings Clinic (Billings, MT)
- …leadership and Physician Advisor, per department process or procedure *Insurance and Utilization Management *Maintains working knowledge of CMS requirements and ... prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN CARE MANAGEMENT (Billings Clinic… more
- BayCare Health System (Cotton Plant, AR)
- …and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and compassionate team. ... **The Utilization Review Specialist Senior responsibilities include:** + Functions as...services + Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials.… more
- Banner Health (AZ)
- …team format. PREFERRED QUALIFICATIONS Previous experience with behavioral health utilization management . Additional related education and/or experience ... remote and hybrid work settings. As a Behavioral Health Utilization Care Manager, you will be assigned to various...internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts… more
- Amity Foundation (Tucson, AZ)
- …individual is responsible for performing a variety of concurrent and retrospective utilization management -related reviews and functions and for ensuring that ... to teach, learn and join our community as a Utilization Review Specialist at our campus in Tucson, AZ....are getting completed. + Other duties as assigned by supervisor . What You Will Bring: + Hands-on knowledge of… more
- Sharp HealthCare (San Diego, CA)
- …time for routine, urgent and expedited referrals as outlined in SCMG's Utilization Management Plan.Decisions will be communicated to the appropriate persons ... + Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, established criteria such as… more
- Sharp HealthCare (San Diego, CA)
- …+ Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, established criteria such as ... is appropriate for the referral request being reviewed.Document in the referral management system, according to SCMG operational processes, actions taken on each… more
- CVS Health (Columbus, OH)
- …is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the ... wellness. Services strategies, policies and programs are comprised of network management and clinical coverage policies.What is A1A?Aetna One Advocate is Aetna's… more