- 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
- AdventHealth (Tampa, FL)
- …such as heart failure, cancer and other diseases. **The role youll contribute:** The Utilization Management RN Supervisor reports directly to the Divisional ... members will have defined reporting accountabilities directly to Supervisors. The Utilization Management RN Supervisor is responsible for the daily… more
- Centene Corporation (Jefferson City, MO)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… 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 ... sets (Medicare Guidelines InterQual Health Plan Benefit Interpretation Guidelines and Medical Management Policies and DHMF Utilization Management guidelines… more
- Molina Healthcare (San Antonio, TX)
- …Nurse who be licensed in the state they reside. We are looking for a RN Supervisor to manage a utilization management team supporting 14 Marketplace plans. ... (CST) - Flexibility to cover rotating weekend shifts Preferred candidate with Utilization Management and leadership experience (Direct Reports) Compact RN… more
- AmeriHealth Caritas (Newark, DE)
- …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... and efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon to: + Conduct utilization … more
- AmeriHealth Caritas (Washington, DC)
- …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs **Responsibilities** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- WellSpan Health (York, PA)
- …peer cases for need of retrospective external appeal-and funnel those cases to the Supervisor of Utilization Management for expedition. + Reviews cases ... Management staff. **Duties and Responsibilities** **Essential Functions:** + Renders utilization management determination in accordance with State and Federal… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print... Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 - $167,136.48 Annually Location Los… more
- Spectrum Billing Solutions (Skokie, IL)
- …cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing team. The UR Supervisor ... and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for treatment… more
- Hackensack Meridian Health (Old Bridge, NJ)
- …a leader of positive change. The role of ** Supervisor , Care Management ** integrates and coordinates utilization management , care coordination, discharge ... acute care setting. + Familiar with hospital resources, community resources, and/or resource/ utilization management . + Care coordination, case management or… more
- Veterans Affairs, Veterans Health Administration (Hot Springs, SD)
- …are not limited to, monitoring their own workload and clinical volume. Assists OT supervisor in utilization and management of available space for current, ... and solve problems in order to meet multiple deadlines. Assists the OT Supervisor in utilization review activities, quality improvement, and other administrative… 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
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role...requirements are met + Additional duties as requested by supervisor + Maintains knowledge of CMS, State and NCQA… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse!Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ... Working under the general supervision of the Director and/or Manager/ Supervisor of Medical Management , and in collaboration...activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …encourage you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and ... attendance is expected and required. + Performs other functions as assigned by management . Level II (in addition to Level I Accountabilities) + Assists and performs… more
- CVS Health (Harrisburg, PA)
- …Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization . The Utilization Management Clinician will work in ... conjunction with the Clinical Supervisor and Medical Directors to facilitate optimal care/treatment. **Schedule:** Monday-Friday 9-:00 AM-5:30 PM EST. No holidays… more
- Helio Health Inc. (Syracuse, NY)
- …Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management ... track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our Inpatient,… more
- Mohawk Valley Health System (Utica, NY)
- RN Supervisor Case Management - Full Time - Days Department: CARE MANAGEMENT SERVICES Job Summary The Supervisor Case Management - SNH is responsible ... for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include the supervision and… more
- Ellis Medicine (Schenectady, NY)
- + The Supervisor of Case Management and Social Work (CMSW) assists with the daily operations of the Department. This person can assist with the hiring and ... of stay (LOS) and cost per case through resource management . + The Supervisor of CMSWS is...CMSWS assist with providing the link between compliance, clinical management , patient progression, gathering and reporting of utilization… more