- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse Reviewer RN II, under the… more
- Kepro (Chicago, IL)
- …. Manages the day-to-day operations for Clinical Operations, Utilization Management , and/or Clinical Reviewers, assuring quality customer service and ... + 3+ years of Case Management and/or Utilization Review experience. + Knowledge of clinical ...judgment for decision-making and guiding staff. + Experience in quality management , including involvement in projects, reporting… more
- CVS Health (Richmond, VA)
- …other internal and external constituents in the coordination and administration of the utilization /benefit management function. + Utilizes clinical skills to ... make health care more personal, convenient and affordable. This is a fully **remote** Utilization Review Clinical Consultant with a schedule of Monday - Friday.… more
- Hartford HealthCare (Wethersfield, CT)
- …is *your moment.* **Job:** **Administrative* **Organization:** **Hartford HealthCare Corp.* **Title:** * Utilization Management Assoc / Clinical Resource ... Resource Management Associate's focus is on providing support and coordination of utilization management services for the utilization management … more
- CVS Health (Baton Rouge, LA)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is knowledgeable ... with other products, services and/or programs. + Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization . +… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical Utilization Management ... Administration, or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health… more
- HonorHealth (Scottsdale, AZ)
- …advisor team. Facilitates peer to peer review with payer as directed. Retrieves utilization management clinical requests and handles each appropriately ... and close to 2,000 volunteers dedicated to providing high quality care, HonorHealth strives to go beyond the expectations... Clinical Value, assists in the administration of Utilization Management functions to include, but not… more
- Kepro (Minneapolis, MN)
- …vital partner for health solutions in the public sector. Acentra is looking for a Utilization Management - Mental Health Clinical Reviewer to join our ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Long Term Services & Support Utilization Management Clinical Educator, RN** Location: Remote, United States Primary Job Function: Medical Management ... about us at www.amerihealthcaritas.com. As part of the Community Health Choices LTSS Utilization Management (UM) Review Team, the [ design title] is responsible… more
- Kepro (AR)
- …team. Summary Description The Dental Clinical Specialist is responsible for the Utilization Management and Utilization Reviews to ensure the timely ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...with a turnaround time for all first-level reviews. + Utilization Management data will be reported each… more
- Randstad US (Boston, MA)
- …medical billing, coding and/or customer service experience. + Knowledge of utilization management process (ie, Health Center, Hospital, Insurance Company, ... clinical support specialist - utilization mngmt. +...Physician office) + Knowledge of Utilization Management regulations and standards + Experience with… more
- Kepro (CA)
- …a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team in California. Job Summary ... As a Utilization Clinical Reviewer, you'll harness your expertise...a focus on meeting production targets and maintaining top-tier quality assurance standards, this role serves as the linchpin… more
- Stanford Health Care (Palo Alto, CA)
- …improvement and participate in quality assurance activities related to utilization management . + Maintain SHC guidelines, federal and state regulations, ... **This is an onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will be responsible for ensuring… more
- Point32Health (Canton, MA)
- …committees to identify, plan and implement Point32Health strategic expansion initiatives, utilization management and/or clinical operations strategies. + ... and division based Behavioral Health leaders to support appropriate utilization of health care services and quality ...Health Care Services to internal and external clients regarding clinical operations, utilization management , complex… more
- The Cigna Group (Franklin, TN)
- …overall clinical compliance within the UM programs, including matters concerning clinical policy, quality management (QM), program development, review of ... The Chief Medical Officer (CMO) Utilization Management will develop and manage...programs + Collaborate with Operations leadership to ensure optimal clinical quality and operational efficiency of all… more
- Catholic Health Initiatives (Lexington, KY)
- … trends, patterns, and impact to appropriate departmental, Utilization Management , Revenue Cycle, Payer Strategy, and Clinical Joint Operating Committees. ... requirements, and reviews and analyzes UM program outcomes and quality metrics. **Essential Key Job Responsibilities** 1. Manages programs...+ Minimum 3 years of clinical case management ( Utilization Management , Denial … more
- Commonwealth Care Alliance (Boston, MA)
- … team.collaboration with the broader clinical organization. + Ensures that utilization management processes are integrated with care management and ... collaborates with the Behavioral Health UM team the multiple clinical groups and provider partners in care management...and leads and organizes the ongoing evaluation of the utilization management program against quality … more
- CareFirst (Baltimore, MD)
- …Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred Qualifications:** + ... based on business needs and work activities/deliverables that week. The Director, Utilization Management provides strategic leadership of the utilization … more
- UNC Health Care (Raleigh, NC)
- …clinical experience in a medical facility and/or comparable Utilization Management experience. **Knowledge/Skills/and Abilities Requirements:** **Job ... discharge for quality , efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical ...The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure patient… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …and collaborating with multidisciplinary teams, influence and direct the delivery and quality of patient care. A hospital-based case management system has ... of administrative/ clinical support staff responsible for assisting with case management for an assigned patient caseload. OTHER + Participates in department… more