- Universal Health Services (Memphis, TN)
- …and love what you do! We are currently hiring a full time Director of Utilization Management ( UM ) for Compass Intervention Center! The UM Director ... with the medical staff, management team and all other departments. The UM Director performs other duties as assigned. Compass Intervention Center is a… more
- CVS Health (Springfield, IL)
- … in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds ... support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities TheCorporate Director of Clinical Utilization Management ( UM )provides comprehensive ... tracking on department and individual team productivity. The Corporate Director of Clinical UM assesses needs, plans,...A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a… more
- Point32Health (MA)
- …partner entities at the direction of Behavioral Health Medical Director Team Leader for Utilization Management ( UM ) and/or the Medical Director of ... Summary** The Behavioral Health Psychologist Reviewer will primarily perform utilization management and provider payment reviews for...and appeals. They will work closely with colleagues in UM and Medical Management , and with other… more
- Sharp HealthCare (San Diego, CA)
- …+ Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, established criteria such as ... requirements for the position, and employer business practices. **What You Will Do** The UM Resource Coord-SCMG serves as a resource to the various teams in the SCMG… more
- Elevance Health (Chicago, IL)
- … clinical operations business inside a health plan or a UM /benefits management firm - Utilization management or clinical experience with post-acute care, ... you for payment as part of consideration for employment. ** Director of Medical Mgmt, Post Acute Care UM...clinical reviews for a set of Post Acute Care Utilization Management solutions and complex cases such… more
- Elevance Health (Columbus, OH)
- …being performed. Preferred: -Leadership experience managing teams of physicians in a utilization management clinical operations business inside a health plan or ... for payment as part of consideration for employment. **Senior Medical Director , Clinical UM Operations** + Job Family: MED...a UM /benefits management … more
- Apex Health Solutions (Houston, TX)
- …Medical Management Supervisor (s): UM Supervisor or Manager of Medical Management Summary Utilization Management ( UM ) Analyst represents the ... leadership in ensuring regulatory compliance, accuracy, and consistency of UM processes. The Utilization Management ... UM Reviewer, Medical Management Manager ( UM Manager) and/or Health Solutions Medical Director .… more
- Elevance Health (Mason, OH)
- …a check, or ask you for payment as part of consideration for employment. ** UM Medical Director - Cardiology** + Job Family: MED > Licensed ... clinical program and/or independently performs clinical reviews. + The Medical Director typically has program management responsibilities including clinical… more
- Apex Health Solutions (Houston, TX)
- Job Title: Coordinator, Utilization Management Department: Medical Management Supervisor: UM Supervisor/Manager, Medical Management The ... UM Reviewer, Medical Management Manager ( UM Manager) and/or Health Solutions Medical Director ....Assistance or similar associates degree preferred Previous experience in utilization management or healthcare operational or a… more
- YesCare Corp (Brentwood, TN)
- …issues relating to the outpatient/inpatient UM process to the Manager of Utilization Management . + Assist with the data collection and reporting related to ... **Experience & Requirements** + Experience Level: 3 - 5 year's experience in utilization management , case management , quality management . Experience with… more
- CVS Health (Phoenix, AZ)
- …and services both inpatient and outpatient services requiring precertification. + Utilization Management nurses use specific criteria to authorize ... procedures/services or initiate a Medical Director referral as needed. + Position requires proficiency with...providers. Required Qualifications + 1+ year: Oncology and Transplant UM , concurrent review or prior authorization + 3+ years:… more
- CVS Health (Columbus, OH)
- …Required Qualifications: -3+ Years of clinical experience -1+ Year of Utilization Review Management and/or Medical Management experience. ... nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. For more information on our benefit programs, please… more
- Providence (Seattle, WA)
- **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote. The role requires a broad knowledge and ... focus on Utilization Management and Denials principles such as...requires the ability to consistently lead, support, and coach UM /UR staff and leaders. The position requires excellent interpersonal… 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 (Outpatient) Job Category:...LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists … more
- Universal Health Services (Bradenton, FL)
- Responsibilities Palm Shores Behavioral Health is currently seeking a Director of Admissions and Utilization Management Palm Shores Behavioral Health Center ... a proud provider of the Patriot Support Program. The Director of Admissions/ Utilization Management is...is responsible for the hiring and development of the UM Coordinator and the Admission Coordinator positions. This position… more
- Guthrie (Sayre, PA)
- Position Summary: The Utilization Management ( UM ) Reviewer, in collaboration with other internal and external offices, payors, and providers and staff, is ... responsible for the coordinates Utilization Management ( UM ) processes and...the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. a) Serves… more
- Dignity Health (Rancho Cordova, CA)
- …home.** **Position Summary:** Under the guidance and supervision of the department Manager/ Director , the Supervisor of Utilization Management is responsible ... the relationship between the Pre-Authorization team and the Medical Director and Physician Reviewers. - Tracks cost savings from...clinical experience required. - Three to five (3-5) years Utilization Management ( UM ) experience required.… more
- LA Care Health Plan (Los Angeles, CA)
- …admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires ... and to support the safety net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II is primarily responsible… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will...and reports are maintained and referred to the Physician Advisor/ UM Director . Documents in platform/system of record.… more