- CVS Health (Phoenix, AZ)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. Gathers clinical information and ... to promote quality effectiveness of healthcare services and benefit utilization . Required Qualifications: + 3+ years clinical practice experience required.… 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
- CVS Health (Frankfort, KY)
- … 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
- Baylor Scott & White Health (Temple, TX)
- …Is accountable to provide professional leadership and direction in the utilization /cost management (UM) and clinical quality improvement (QI) of the ... + Provide periodic written and verbal reports and updates as required in the Quality Management Program description, the Annual QI Work Plan. + Assure plan… more
- CVS Health (Richmond, VA)
- …staff to facilitate notice of action delivery. Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization . Consults ... internal and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications : - Must have… more
- Providence (Seattle, WA)
- …with analysts to provide direction and consultation on utilization management systems and programs and quality initiatives. Identifies opportunities to ... business administration, social science or other related field (preferred) + Certification in utilization management or quality improvement (preferred) + 10… more
- Kepro (Los Angeles, CA)
- …is fueled by passion and driven by purpose. Position Overview As a Utilization Clinical Reviewer, you'll harness your expertise to meticulously evaluate medical ... Following a 2022 merger of CNSI and Kepro, Acentra Health combines clinical services, technology solutions, and data analytics to accelerate better health outcomes.… more
- UNC Health Care (Chapel Hill, 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
- Humana (Columbus, OH)
- …departments, providers, and community partners to support the delivery of high- quality utilization management services, including introducing innovative ... in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical...and maintains staffing levels to meet care and service quality objectives. + Conducts timely evaluations of direct reports… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- … trends, patterns, and impact to appropriate departmental, Utilization Management , Revenue Cycle, Payer Strategy, and Clinical Joint Operating Committees. ... Franciscan Health, you will find the safest and highest quality of care provided by our expert, compassionate medical...+ Minimum 3 years of clinical case management ( Utilization Management , Denial … more
- CVS Health (Raleigh, NC)
- …team supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. -Utilizes clinical experience and skills… more
- CVS Health (Columbus, OH)
- …There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. - Utilizes clinical experience and… more
- Centene Corporation (Raleigh, NC)
- …to performance, compliance, quality , and efficiency standards + Collaborates with utilization management team to resolve complex care member issues + ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services... utilization management team and senior management to identify opportunities for process and quality… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or CM. Knowledge of Department of Health Care Services… more
- Centene Corporation (Sacramento, CA)
- …team goals and objectives + Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards + Assists ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...Review team to ensure appropriate care to members. Manages utilization management issues related to member care,… more
- Sharp HealthCare (San Diego, CA)
- …the episode of care and supports other members of the System Centralized Utilization Management team to ensure final status reconciliation. This position ensures ... technical resource and service, as well as performance and quality . This position supports the ICM model of patient-centric...Degree in a health related field + 3 Years Utilization Management or case management … more
- AmeriHealth Caritas (Newark, DE)
- …validation of regulatory reporting/analytics for UM DE, and serves as SME for clinical components DE Medicaid Utilization Management Program. Works in ... and administrative procedures. + Serve as designee for LOB Quality Meetings, corporate UM meetings, state UM meetings and... clinical practice required + 3+ years of utilization management experience + Demonstrated ability to… more
- Beth Israel Lahey Health (Burlington, MA)
- …Physician Advisor will play an active role in optimizing healthcare resource utilization , ensuring quality , patient care, and managing valuable organizational ... to challenge physician practices to achieve the organization's desired resource management and quality goals. **Job Description:** Purpose: Provide leadership… more