- Molina Healthcare (Bronx, NY)
- …and the site of service. **We are seeking a Registered Nurse with previous UM and** **inpatient experience along with knowledge of the NYS Medicaid guidelines** . ... Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review , and/or other utilization management activities aimed at providing… more
- Apex Health Solutions (Houston, TX)
- Job Title: UM Analyst Department: Medical Management Supervisor (s): UM Supervisor or Manager of Medical Management Summary Utilization Management ( UM ... and concurrent approvals/denial correspondences and notifying providers/enrollees needed. Collaborating with the UM Supervisor to resolve inquiries and UM … more
- Apex Health Solutions (Houston, TX)
- Job Title: Coordinator, Utilization Management Department: Medical Management Supervisor : UM Supervisor /Manager, Medical Management The Utilization ... approvals/denial correspondences and notifying providers/enrollees needed. Collaborating with the UM Supervisor to resolve customer service inquiries and… more
- Sharp HealthCare (San Diego, CA)
- …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 ... UM Department. Prepares referral requests for outpatient services, elective...and authorizes medical services that meet medical criteria. The review of care is region specific and consists of… more
- Sharp HealthCare (San Diego, CA)
- …Sharp Extended Care (SEC) provider on site and/or telephonically. Keeps SEC Nurse Supervisor or SEC provider of any adverse development, delay in discharge or ... Informs quality department of any quality issues. + Chart review Performs a comprehensive review of medical...issues. + Chart review Performs a comprehensive review of medical history, doctor's orders, progress notes, therapy… more
- Dignity Health (Rancho Cordova, CA)
- …Under the guidance and supervision of the department Manager/Director, the Supervisor of Utilization Management is responsible and accountable for coordination of ... supervision this position is responsible for coordinating the daily operations of the UM Pre-Authorization team in order to ensure requests are processed in a… more
- LA Care Health Plan (Los Angeles, CA)
- …RN II is responsible for ensuring that delegates contracted to perform Utilization Management ( UM ) functions on behalf of LA Care (LAC) is in compliance with all ... UM regulatory requirements and new legislation through the maintenance...through these processes. Prepares the Delegation Oversight Department for review by external regulatory bodies. Ensures that the Delegation… more
- Centene Corporation (Raleigh, NC)
- …perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency… more
- University of Michigan (Ann Arbor, MI)
- Contact Center Supervisor Apply Now **How to Apply** A cover letter is required for consideration for this position and should be attached as the first page of your ... and experience that directly relate to this position. **Summary** The Contact Center Supervisor will lead a team of Contact Center Representatives whose focus is on… more
- University of Miami (Miami, FL)
- …. The University of Miami is currently seeking a Supervisor , Medical Technologists to work at the UM ... Miami. The incumbent will supervise laboratory personnel and schedules. The Supervisor , Medical Technologists will participate and assign weekly responsibilities to… more
- Billings Clinic (Billings, MT)
- …here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN CARE MANAGEMENT (Billings Clinic Main ... loan reimbursement Under the direction of department leadership, the Utilization Review / Management RN. This position is to conduct initial, concurrent,… more
- Pacific Medical Centers (Seattle, WA)
- **Description** The Supervisor Care Management RN is responsible for the supervision of case management (CM) and utilization management ( UM ) functions of US ... referrals are reviewed and processed in a timely manner. It includes timely review of medical necessity and authorization for all admitted patients and outpatient… more
- Highmark Health (Columbus, OH)
- …This job supervises and coordinates the day to day activities of the UM Intake Coordination team. The incumbent selects, develops and continuously coaches staff to ... department in compliance audits as it relates to the supervisor functions. + Act as subject matter expert for...with providers via phone.At times, build cases in Utilization Review system during high volume times. + Other duties… more
- InnovaCare (San Juan, PR)
- …the business. MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient utilization of ... visits to Acute, SNF, and Rehabilitation Inpatient facilities to concurrently review admissions and continued stay to determine appropriate Utilization, Quality… more
- Sharp HealthCare (San Diego, CA)
- …the problem, apologizing, tracking the situation, and then presenting it to the PT Supervisor or supporting clinical specialist (PT II or PT III) for resolution in a ... and customer service will be measured by PT Spec III or Supervisor observation, physician and peer feedback, SharpStar nominations and written or verbal… more
- Sharp HealthCare (San Diego, CA)
- …+ Ability to consult effectivelyAbility to consult with other staff or with supervisor if treatment techniques being used are not producing desired results within ... of discharge.Follows policies and procedures for all Utilization Management ( UM ), discharges, Standardized Outcome Measures, Durable Medical Equipment (DME) forms… more
- The Arora Group (Bethesda, MD)
- …high cost diagnoses. + Independently perform difficult and complex assessment, review , coordination, planning, monitoring, evaluation and analysis of cases. + Screen ... to the Nurse Manager, and take direction from the charge nurse and house supervisor as required in maintaining a safe environment for staff and patient(s). +… more
- University of Miami (Coral Gables, FL)
- …. Additional materials may be requested at a later date Please apply through the UM Career Site. Review of applications will begin immediately and will continue ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ideal candidate… more
- University of Michigan (Dearborn, MI)
- …interpersonal and communication skills. **Who We Are** The University of Michigan-Dearborn ( UM -Dearborn) is one of the three campuses of the University of Michigan ... system. UM -Dearborn is a comprehensive university offering high-quality undergraduate, graduate,...action requests) including salary changes, student terminations, change in supervisor , change in working title. + Posts all temporary… more
- Baystate Health (Springfield, MA)
- …(LPN) functions under the supervision and guidance of the Nursing Supervisor , Physician, or Advance Practitioner and participates in the multi-disciplinary process ... clinical liaison between the primary care team and HNE UM staff. Under the direction of an RN, the...to provide to HNE to support the medical necessity review process and plan of care. + Support a… more