- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Quality Reporting and Auditing Specialist I Job Category: Clinical Department: Utilization Management Location: Los ... required to achieve that purpose. Job Summary The Utilization Management (UM) Quality Reporting and Auditing Specialist I is responsible for dynamically… more
- Molina Healthcare (Lexington, KY)
- …candidate will have experience working with the clinical departments including utilization management /authorizations + Experience working with Managed Care/Payer ... healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare … more
- Commonwealth Care Alliance (Boston, MA)
- …advance the UM program and leads and organizes the ongoing evaluation of the utilization management program against quality and utilization benchmarks ... provider related issues. * Directs the work of the utilization management team to ensure quality...issues and concerns and corrective action plan activities and reporting . * Provides expert input to Finance regarding patterns… more
- UNC Health Care (Morrisville, NC)
- …the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible ... for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a complex academic health system and… more
- 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: Full ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for… more
- McLaren Health Care (Port Huron, MI)
- …hospital **Preferred:** ⦁ Experience in utilization management /case management , critical care, clinical documentation, or patient outcomes/ quality ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- Intermountain Health (Las Vegas, NV)
- …including social work and complex care planning, transitions of care, and utilization management . The position ensures compliance with state, national, and ... The Manager of Care Management I leads and collaborates with care management operations across utilization review, acute and emergency department care, and… more
- Beth Israel Lahey Health (Plymouth, MA)
- …Management Certification required + Minimum of 3 years of progressive experience in utilization management and appeal/denial management . + Holds a strong ... a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager -...proud to be a trusted healthcare provider, offering personalized, high- quality care to the South Shore of Massachusetts. As… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …of or ability to learn financial management related to UR function and reporting , quality improvement processes, and human resources management * Able to ... review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Staff Nurse*to join our Utilization Management department for the/Emergency Department / This position is a*0.8 FTE (8 ... *Assessment:* * Collects, reviews, and documents clinical data relevant to utilization management , including patient status, treatment plans, and healthcare… more
- Saint Francis Health System (OK)
- …placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the ... not all inclusive nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location: Virtual Office, Oklahoma 73105… more
- Saint Francis Health System (Tulsa, OK)
- …not all inclusive nor does it prohibit the assignment of additional duties. Utilization Management - Laureate Campus Location: Tulsa, Oklahoma 74136 **EOE ... of care process improvement. Identifies QI Triggers for individual patient situations, reporting them promptly to the Process Improvement/ Quality Director, to… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- Guthrie (Sayre, PA)
- …$25,000 Sign On Bonus For Qualified RNs! Summary The Registered Nurse (RN) Utilization Management (UM) in collaboration with Care Coordination, Guthrie Clinic ... with CPT/ICD coding, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer applications (such as… more
- Wellpath (Lemoyne, PA)
- …The Medical Director of Utilization Management leads and oversees utilization review, case management , quality improvement, and related policy and ... direction to medical staff in their efforts to ensure quality patient care and the appropriate utilization ...utilization of medical services. The Medical Director of Utilization Management serves as a key liaison… more
- YesCare Corp (Brentwood, TN)
- …+ Communicate and guide staff and physicians regarding utilization management program development, implementation, and evaluation and reporting .Match the ... license + No less than 5 years' experience in utilization management , case management , quality management . + Experience with InterQual and/or… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... in department and hospital performance improvement activities; Responsible for outcomes reporting , quality , and Lean process improvements, and facilitating the… more
- Ochsner Health (Jefferson, LA)
- …This job manages expense management , vendor relationships, contract management , standardization and consolidation processes and utilization analysis. ... supply utilization improvements. + Good judgment, organizational and time management skills. + Consulting and group presentation skills. + Ability to travel… more
- HonorHealth (AZ)
- …Performs medical record reviews, as required by payer. Interfaces with Care Management team to provide information regarding quality outcome measurements (such ... -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of health… more
- University of Rochester (Rochester, NY)
- …Using clinical judgment and available resources, develops and oversees medication management procedures and strategies to ensure safe and compliant receiving, ... controlled substance handling and rules/regulations. Responsible for education of staff and reporting out of key metrics to pharmacy leadership related to this… more