- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management ( Authorization ) Unit is primarily responsible for ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager, Utilization Management reports to the Director of … more
- Strada (Magnolia, TX)
- …people powered company committed to delivering world-class payroll, human capital management , and financial management solutions to organizations globally. With ... to work. To learn more about us, visit stradaglobal.com Tax Filing Director (CPA Required) Leadership role responsible for the overall quality day-to-day delivery… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …of Texas or compact license + 3+ years Nursing experience + 1+ years Utilization Management and Appeals experience + Excellent verbal, written and computer ... advocates on behalf of Members and families for out-of-network authorization approvalsImplement: Identifies problems, barriers, and opportunities within processes… more
- Centene Corporation (Richmond, VA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… 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
- Tufts Medicine (Burlington, MA)
- … review and management . The position develops and leads the Utilization Management operations, strategy and implementation of the Utilization ... 1. Bachelor of Science in Nursing (BSN). 2. RN Licensure. 3. Current certification in case/ utilization management (ACM, CCM, CMAC) 4. Seven (7) years of UM/Case … more
- Centene Corporation (Richmond, VA)
- …activities including peer-to-peer requests, authorization entry, and discharge data management . + Leads utilization management team on performance, ... including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of… more
- Centene Corporation (Sacramento, CA)
- …experience with prior auth is highly preferred** **Position Purpose:** Directs the utilization management team to ensure the appropriate application of policy ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management ( Authorization ) Unit is primarily responsible for ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager, Utilization Management reports to the Director of … 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...and other hospital departments as appropriate to obtain prior authorization required to meet contractual reimbursement requirements and to… more
- LA Care Health Plan (Los Angeles, CA)
- …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II...the discharge planning process, including providing clinical review and authorization for alternate levels of care, home health, durable… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Manager, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support ... retrospective reviews. Primary Responsibilities + Coordinate day to day operations of the Utilization Management team. + Serve as the primary contact for… 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
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... admissions and extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key contact for facility… more
- Saint Francis Health System (Tulsa, OK)
- …in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal ... for review intervals, supplying the required clinical information to obtain authorization . Responds promptly to authorizing entity's need for further detail.… more
- Martin's Point Health Care (Portland, ME)
- …of clinical nursing experience as an RN, preferably in a hospital setting + Utilization management experience in a health plan UM department Required License(s) ... for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well as specified… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM) is a Registered Nurse (RN) who assists to control costs for VISN 10 and/or VISN 12 while ... appropriate evidence-based practices for positive outcomes. Responsibilities The Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM) is directly… more
- LA Care Health Plan (Los Angeles, CA)
- …that purpose. Job Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical ... Authorization Technician II (12 Month Assignment) Job Category:...clinical staff to render decisions, assists the Manager and Director of the Utilization Management … more
- Houston Methodist (Houston, TX)
- …oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for ... At Houston Methodist, the Sr Director Case Management position is responsible...needed. + Collaborates with HMCPA on care transition and utilization management initiatives. + Provides strategic vision… more
- Sharp HealthCare (San Diego, CA)
- …to accrediting and regulatory agency feedback. + Supports pre-admission review, utilization management , and concurrent and retrospective review Process. Performs ... + Participates in risk management reviews. + Assists in pharmacy utilization management , catastrophic case review, outreach programs, HEDIS reporting, site… more
