- Hackensack Meridian Health (Hackensack, NJ)
- …standards, and regulatory/payor requirements. The role integrates and coordinates utilization management , care coordination, discharge planning functions and ... performance improvement activities for the case managers. The Supervisor Case Management is accountable for the...needs, manage the length of stay, and promote efficient utilization of resources; specific functions within this role include:… more
- Centene Corporation (Tallahassee, FL)
- … team to 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 +… more
- Dignity Health (Rancho Cordova, CA)
- …Summary:** Under the guidance and supervision of the department Manager/Director, the Supervisor of Utilization Management is responsible and accountable ... (Medicare Guidelines, InterQual, Health Plan Benefit Interpretation Guidelines and Medical Management Policies, and DHMF Utilization Management guidelines… more
- Commonwealth Care Alliance (Boston, MA)
- …case review , workflow review and other relevant business related to utilization review process. + Works in collaboration with the UM Manager to promote ... **Why This Role is Important to Us:** Supervisor & The Team Leader reports to the...and leadership with the development, refinement and enhancement of utilization management workflows, policies and procedures. +… more
- Immigration and Customs Enforcement (IN)
- …Appropriately refers cases for high level of review and participates in Utilization Management Review Committee activities as needed. Incumbent reviews ... Assistant Director for Healthcare Compliance, Office of Health Plan Management . The Senior Utilization Review ...be approved and clearly documented. The officer keeps the supervisor informed of the status on projects and consults… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN CARE ... loan reimbursement Under the direction of department leadership, the Utilization Review / Management RN. This...concerns they have in this regard with their immediate supervisor and/or the Vice President People Resources. All employees… more
- BayCare Health System (Cotton Plant, AR)
- …responsibility and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and ... compassionate team. **The Utilization Review Specialist Senior responsibilities include:** +...Review or + Required 2 years in Case Management + Preferred 3 years Registered Nurse in Critical… more
- Amity Foundation (Tucson, AZ)
- …individuals with a desire to teach, learn and join our community as a Utilization Review Specialist at our campus in Tucson, AZ. With this groundbreaking ... community building Remembrance, Resolution, Reconciliation, Restoration, Renewal About the Position Utilization Review Specialist you will contribute to the… more
- Commonwealth Care Alliance (Boston, MA)
- …and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets ... review for medical necessity and decision-making. The Utilization Management Reviewer has a key role...of denied service requests Additional duties as requested by supervisor **Working Conditions:** + Standard office conditions. + Weekend… more
- Universal Health Services (Bradenton, FL)
- …alternate treatment sources when appropriate. The Director of Admissions/ Utilization Management performs admission and concurrent review of patients. Assures ... Health is currently seeking a Director of Admissions and Utilization Management Palm Shores Behavioral Health Center...Health field + Two (2) years experience as a supervisor or in a leadership capacity + Stable emotional… more
- Sharp HealthCare (San Diego, CA)
- …time for routine, urgent and expedited referrals as outlined in SCMG's Utilization Management Plan.Decisions will be communicated to the appropriate persons ... + Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, established criteria such as… more
- Sharp HealthCare (San Diego, CA)
- …+ Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, established criteria such as ... necessity reviews and authorizes medical services that meet medical criteria. The review of care is region specific and consists of outpatient healthcare services… more
- CVS Health (Columbus, OH)
- …is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the ... wellness. Services strategies, policies and programs are comprised of network management and clinical coverage policies.What is A1A?Aetna One Advocate is Aetna's… more
- Molina Healthcare (Bronx, NY)
- …team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management activities ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- Universal Health Services (Shippensburg, PA)
- Responsibilities Clininical Supervisor - Social Work/ Utilization Management Roxbury is currently hiring a Clinical Supervisor to oversee the clinical ... directly to the Director of Clinical Services. The Clinical Supervisor , Social Work/ Utilization Review , provides...If you would like to learn more about the Supervisor , Social Work/ Utilization Management position… more
- Pacific Medical Centers (Seattle, WA)
- …USFHP Medical Director(s) to develop and implement strategic case management and utilization management yearly goals. The Supervisor Care Management ... **Description** The Supervisor Care Management RN is responsible for the supervision of case management (CM) and utilization management (UM)… more
- CareFirst (Baltimore, MD)
- …Licensure. **Experience:** 3 years Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient ... **Resp & Qualifications** **PURPOSE:** The Care Management Supervisor supervises, directs and coordinates...years Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Research and Performance Management Unit Supervisor / Human Services Supervisor 4** **Job Class: Human Services Supervisor 4** **Agency: ... workforce dedicated to creating a better Minnesota. **The Research and Performance Management Unit Supervisor will provide leadership and supervisory oversight… more
- Centene Corporation (Tallahassee, FL)
- … policies, procedures and processes. + Facilitate on-going communication between case management staff, utilization management staff and contracted ... a medical/surgical, pediatrics, or obstetrics environment. 1+ year of case and/or utilization management experience. Working knowledge of a specialized or… more
- Bassett Healthcare (Oneonta, NY)
- …to staff regarding "new" therapeutic modalities and medications (measured by peer review and management .) Assists Clinical Coordinators in training of new ... and continuing Education of current employees (measure by peer review and management observation) Act as a...techniques measured by documentation of inservice log sheet, peer review and supervisor observation. Reports promptly, any… more