- Molina Healthcare (GA)
- …of Georgia. JOB DESCRIPTION Job Summary Leads and manages multidisciplinary team of healthcare services professionals in some or all of the following functions: ... and supports (LTSS), and/or member assessment. * Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal… more
- Molina Healthcare (GA)
- …Licensure. JOB DESCRIPTION Job Summary Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: ... one or more of the following key health care services functions: care management, utilization management, care...clinical services . * Collaborates with and keeps healthcare services senior leadership informed of operational… more
- Molina Healthcare (Los Angeles, CA)
- …preferred** **JOB DESCRIPTION** Job Summary Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following ... functions: care management, utilization management, behavioral health, care transitions, long-term ...of protocols and guidelines. * Collaborates with and keeps healthcare services leadership apprised of operational issues,… more
- Prime Healthcare (Anaheim, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/218947/case- manager utilization ... acute-care hospital dedicated to providing the community with high-quality, compassionate healthcare . Key services include general medical and surgical inpatient… more
- Prime Healthcare (Chino, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/226811/case- manager -%28rn%29 utilization ... community's health care needs with top-rated emergency care as well as senior services , orthopedics, surgical services and more. Learn more atwww.cvmc.com. Join… more
- CVS Health (UT)
- …promote high-quality healthcare for members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This ... team maintains compliance and privacy practices. + Oversees the implementation of utilization management services for assigned area + Implements clinical… more
- Prime Healthcare (Montclair, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/226814/case- manager utilization ... core values of quality, compassion, and community! Why Prime Healthcare ? (https://montclair-hospital.org/careers/why- healthcare -prime/) Montclair Hospital Medical Center is… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and monitoring the utilization of physical health (PH) medical and healthcare services for members, ensuring compliance with internal and external standards ... and post- service clinical reviews to determine the appropriateness of services requested for the diagnosis and treatment of members' medical health conditions,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to work ... * National certification of any of the following: CPHM (Certified Professional in Healthcare Management), CCM (Certified Case Manager ), ACM (Accredited Case … more
- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... is one of Long Island's finest health and human services agencies. Our health system has over 16,000 employees,...acute care hospitals, three nursing homes, a home health service , hospice and a network of physician practices across… more
- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Sep 26, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career ... care and their communities. Role Overview: The role of Utilization Management Manager oversees the integration of...health outcomes through access to high quality care and services . You serve as the utilization management… more
- Centene Corporation (Phoenix, AZ)
- …and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services + Educates and provides ... and tracks achievement against goals and objectives and HBR performance for BH utilization management team to achieve cost-effective healthcare results and to… more
- Humana (Augusta, ME)
- …of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific guidelines and ... caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization...our customers and our company. Through our Humana insurance services and CenterWell healthcare services ,… more
- Beth Israel Lahey Health (Plymouth, MA)
- …As a member of **Beth Israel Lahey Health** , BID-Plymouth provides comprehensive healthcare services to over 250,000 residents in Plymouth and Barnstable ... a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager -...come first. We are proud to be a trusted healthcare provider, offering personalized, high-quality care to the South… more
- Helio Health Inc. (Syracuse, NY)
- …to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting ourSyracuse ... from the effects of substance use, mental health disorders, and other behavioral healthcare issues. To support the mission of Helio Health, theUtilization Case … more
- Sharp HealthCare (San Diego, CA)
- …**Preferred Qualifications** + Master's Degree in Nursing + Master's Degree in a healthcare related field. + Accredited Case Manager (ACM) - American Case ... (RN) - CA Board of Registered Nursing; Certified Case Manager (CCM) - Commission for Case Manager ...and maintain this certification.For Sr Spec ICM assigned to Utilization Management, Train-the-Trainer certification may substitute for ACM or… more
- Molina Healthcare (Orlando, FL)
- … utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review, patient education, ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services /Management staff work to ensure that Molina members...initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and… more
- Catholic Health Services (Melville, NY)
- …teams to ensure timely follow through. + Reviews providers' requests for services and coordinates utilization /appeals management review. + Assist Utilization ... payors. + Serves as a liaison between patient account services , physicians, care coordinators, Utilization and Appeals...and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- …workflow and determines priorities to assure highest quality of care with efficient utilization of available services ; + Schedules, assigns, oversees and reviews ... disciplines when performing case reviews; + Attends professional workshops, seminars and in- service training; + May supervise Utilization Review Nurses and other… more
- Prime Healthcare (National City, CA)
- …surgical services , and 24-hour emergency services . In addition to our healthcare services , we offer comprehensive behavioral health services on the ... and community! Paradise Valley Hospital, a member of Prime Healthcare , offers incredible opportunities to expand your horizons and...proud of our heritage and providing numerous programs and services to meet the changing needs of our community.… more