- Community Based Care of Brevard, Inc. (Orlando, FL)
- Salary: $65,000/year Position Summary: The UM Program Manager provides oversight and management of service authorization data validation, reporting and trend ... line-by-line entries, and submits to finance for payment. The UM Program Manager reconciles ARGOS Dependency Cases...application for daily entry of case activity and the utilization management of service authorizations. Educational and… more
- Molina Healthcare (Syracuse, NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. **Required Qualifications** ... surgical, emergency room, intensive care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work Hours: Monday - Friday 8:00am-… more
- Molina Healthcare (Salt Lake City, UT)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours:...be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and… more
- Humana (Lansing, MI)
- …of our caring community and help us put health first** The Utilization Management Certified Occupational Therapy Assistant 1 ( UM COTA) uses skills to support ... ser vices and supports and/or benefit administration determinations. The UM COTA work assignments involve moderately complex to complex...facing and is part of Humana's Tuberculosis (TB) screening program . If selected for this role, you will be… more
- CenterWell (Annapolis, MD)
- …**Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization review ... work, communication of decisions to internal associates, participation in care management and possible participation in care facilitation with hospitals. The… more
- Centers Plan for Healthy Living (Margate, FL)
- …with the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to ... the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists… more
- UNC Health Care (Morrisville, NC)
- …of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a strategic and operational leader ... information systems (ISD) to create a unified and standardized utilization management ( UM ) infrastructure. This...that impact the success of the organization and the UM program . 2. **Leading People** - Operational… more
- LA Care Health Plan (Los Angeles, CA)
- …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 ... Supervisor, Utilization Management RN Job Category: Clinical...department's performance measures outcomes and goals. Plans and oversees UM activities according to model of care, program… more
- Dignity Health (Bakersfield, CA)
- …remote, but will be expected to work PST business hours.** **Position Summary:** The Utilization Management ( UM ) Trainer (Technical and Systems Focus) will ... authorization details and clinical data. 3. Documentation and Platform Utilization : - Train UM staff on the...**Minimum Qualifications:** - Minimum of 5 years experience in Utilization Management or related managed care functions.… more
- Guthrie (Sayre, PA)
- …To $25,000 Sign On Bonus For Qualified RNs! Summary The Registered Nurse (RN) Utilization Management ( UM ) in collaboration with Care Coordination, Guthrie ... . This role is responsible for ensuring that the UM program maintains documented, up-to-date policies and...coding, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer… more
- Commonwealth Care Alliance (Boston, MA)
- … UM program and leads and organizes the ongoing evaluation of the utilization management program against quality and utilization benchmarks and ... performance monitoring and * Leads the Utilization Management team in managing and continuously improving UM... Management team in managing and continuously improving UM program design, policies, procedures, workflows, and… more
- Integra Partners (Troy, MI)
- …Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES ... process + Understanding the expectations and functions of the UM team + Time Management What will...plus Benefits Offered + Competitive compensation and annual bonus program + 401(k) retirement program with company… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …The Miami VA medical Center is looking for recruit for Registered Nurse - Utilization Management / Float who is responsible and accountable for all elements ... offers a comprehensive total rewards package: VA Nurse Total Rewards The Utilization Management /Float Registered Nurse is located at the Nursing, Perioperative… more
- CommonSpirit Health (Phoenix, AZ)
- …and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials ... care. **Essential Key Responsibilities:** + Leadership & Strategy: Lead the System-level Utilization Management ( UM ) department, ensuring alignment with… more
- LA Care Health Plan (Los Angeles, CA)
- …and to support the safety net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Quality Reporting and Auditing Specialist I is ... responsible for dynamically working with the quality team and UM Leadership to support and ensure effective implementation of...work plans and projects on behalf of LA Care's Utilization Management Quality Program by… more
- LA Care Health Plan (Los Angeles, CA)
- …and to support the safety net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II is primarily responsible ... vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management...+ Tuition Reimbursement + Retirement Plans + Medical, Dental and Vision + Wellness Program + Volunteer Time Off… more
- Alameda Health System (Oakland, CA)
- …service standards for the utilization management operations. Evaluate utilization reviews and determine program improvements. + Develop and implement ... Director, Utilization Management + Oakland, CA +... practices; assists physicians and hospital personnel in understanding UM matters. + Perform all other duties as assigned.… more
- Centene Corporation (New York, NY)
- …ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence ... **Must have an active New York State RN license.** **Inpatient Utilization Management ** **Position Purpose:** Supervises Prior Authorization, Concurrent Review,… more
- Sanford Health (Sioux Falls, SD)
- …Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management ( UM ) activities in accordance with UM ... utilization and potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality of care for… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Serve as the primary contact for day-to-day operational escalations related to the Utilization Management program . + Establish and maintain positive ... About The Role The Manager, Utilization Management ( UM ) will...performance improvement for team members. + Partner with Clinical Program leaders to address audit results to ensure compliance… more