- Conifer Revenue Cycle Solutions (Detroit, MI)
- …process quality and accuracy adherence to process standards Relative cost management metrics goals expense, cost, and margin control monthly, quarterly, and ... annual financial goal management ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others...of hospital budgets and ensures and manages human resource utilization at all levels. Analyzes monthly P & L's… more
- Christus Health (San Antonio, TX)
- …computer applications and the related business processes. Validating competency of users in utilization of information systems prior to systems go-live or major ... Description Summary: Under the direction of the Manager, Director , or other senior personnel, the Project Manager...planning. Maintains project issues and reports to Information System management and local steering teams on the progress of… more
- Fallon Health (Worcester, MA)
- …and clinical functions related to outpatient and inpatient, utilization management operations, including but not limited to prior authorization, concurrent ... + Recommends and implements innovative process improvements for the prior authorization and utilization management ...cost of care opportunities related to Utilization Management . + Works with VP/ Medical Director … more
- CVS Health (Springfield, IL)
- …in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities ( prior authorization and appeals) and responds ... 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
- Prime Healthcare (Inglewood, CA)
- …Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients ... ie full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management… more
- Integra Partners (Troy, MI)
- …funded programs; no OIG sanctions + 5+ years of utilization management experience, including complex case review + Prior leadership experience overseeing ... (Senior MD) serves as the clinical and strategic leader for Integra's Utilization Management (UM) and Credentialing programs. This is a full-time, 40+… more
- Integra Partners (Troy, MI)
- …of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, salaried role functions ... The Utilization Review Medical Director is responsible...or past OIG or state sanctions + Experience performing utilization management or clinical review activities +… more
- Healthfirst (NY)
- …leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requests** + **Develop strong ... maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** +… 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
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials … more
- LifeCenter Northwest (Bellevue, WA)
- …or operational needs. + Collaborate with the Director , Organ Utilization , to manage departmental budgets and identify cost- management opportunities without ... clinical proficiency and participate in on-call schedule as directed by the Director , Organ Utilization , available for consultation outside of regular working… more
- Guthrie (Cortland, NY)
- …Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for ... Summary The LPN Utilization Management (UM) Reviewer, in collaboration...Coordination and other hospital departments as appropriate to obtain prior authorization required to meet contractual reimbursement requirements and… more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of federal,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... financial, and utilization goals through effective management , communication, and...progressive discipline process when appropriate * Collaborates with department director and professional development specialist to develop standard work… more
- South Middlesex Opportunity Council (Framingham, MA)
- …casual Working Conditions: As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact with ... children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. Candidates must… 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 ... and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** +… more
- Integra Partners (Troy, MI)
- … Director ) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES ... external sources + Other duties as assigned by UM Director + Strong organizational skills, ability to adapt quickly...expectations and functions of the UM team + Time Management What will you achieve in the first 12… more
- University of Utah Health (Salt Lake City, UT)
- …trust that are integral to our mission. EO/AA_ + The Staff Utilization Coordinator is responsible for providing healthcare operational support services, including ... Timekeeping team. + Collaborating closely with Nursing Leadership, the Staff Utilization Coordinator reviews and develops schedules based on agreed-upon staffing… more
- George C. Grape Community Hospital (Hamburg, IA)
- …nursing experience (acute care preferred). o Prior experience in utilization review, case management , quality improvement, and infection control strongly ... * Education & Collaboration: o Educate clinical staff on documentation requirements, utilization management processes, and infection control standards. o Serve… more
- Centene Corporation (New York, NY)
- …and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
