- 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
- AnMed Health (Anderson, SC)
- Responsible for performing daily operations of Utilization Management ( UM ) program including certification management , medical necessity ... and regulatory compliance. Qualifications: Requires current SC RN. Minimum of two years of clinical experience required. UM experience preferred but not required. more
- Dignity Health (Bakersfield, CA)
- …related to patient information, PHI and HIPAA regulations. **Preferred Qualifications:** - Utilization Management ( UM ) prior auth experience strongly ... as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the… more
- Molina Healthcare (GA)
- …implementing health management , care management , utilization management , behavioral health and other program activities in accordance with ... JOB DESCRIPTION **Job Summary** The Supervisor, Healthcare Services UM leads and supervises a multidisciplinary team of...professionals in some or all the following functions: care management , utilization management , behavioral health,… more
- Deloitte (San Diego, CA)
- … UM Support & Maintenance + Must have a current Epic Tapestry ( Utilization Management ) certification + Experience in application build and go-live, along with ... who wants to work in a collaborative environment? As an experienced Epic Tapestry UM Analyst you will have the ability to share new ideas and collaborate on… more
- Molina Healthcare (Boston, MA)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * ... We are looking for a candidate with a MA RN licensure. Candidates with UM Medical Review background and experience using MCG or InterQual are highly preferred.… 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
- CVS Health (Workman, MN)
- …Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program . Applies critical thinking and is ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required** **Qualifications** : + Unrestricted… 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
- 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
- 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
- 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
- AdventHealth (Daytona Beach, FL)
- …MEDICAL PKWY, Daytona Beach, 32117 **The role you'll contribute:** The role of the Utilization Management ( UM ) Registered Nurse (RN) is to use clinical ... Days Off from Day One + Student Loan Repayment Program * (For eligible positions) + Career Development + Whole...including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a Utilization Management Analyst to join our Denials Analysis. This full-time role will primarily work remotely, but may ... on-site when needed (Day). *Purpose of this position: *The Utilization Management Analyst plays a critical role...authorization rules, contacts, and changes supporting a denials prevention program * Collaborate with UM staff to… more
- Centene Corporation (Phoenix, AZ)
- …clinicians and ensures compliance with applicable guidelines + Reviews and analyzes BH utilization management ( UM ) activities, over/under utilization , ... to members. Oversees and works with senior leadership on utilization management issues related to member care,...and forecasted data to identify areas for improvement within UM to align to goals and objectives + Manages… 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
- Sutter Health (Sacramento, CA)
- …Advisor will work closely with the medical staff, including house staff, and all utilization management ( UM ) personnel, Care Management (CM) personnel ... organization's goals and objectives for ensuring the effective, efficient utilization of health care services. The PA will develop...of health care services. The PA meets with care management , UM staff and health care team… more
- Centene Corporation (Austin, TX)
- …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. + Maintains… more
- Centene Corporation (Sacramento, CA)
- …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 + Maintains… more