- Marion County (Salem, OR)
- …& Human Services is looking for an adaptable, collaborative, and experienced Program Manager who will assist the department in achieving its mission: To create a ... to the following Program Development & ManagementProvide program development and management /oversight of a diverse group of programs and teams. Program oversight… more
- Sutter Health (Alameda, CA)
- …team to implement the established plan of patient care and ensuring effective management of visit utilization and control of expenses. May assist in ... Sutter Health policy**" Under the supervision of the Clinical Manager , the Primary Care Clinician (PCC) is an experienced...physical therapist who is responsible for the overall case management of home health patients including the provision of… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team ... of UM coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and manage various...(BSN) degree required * Five or more years of utilization management required * Four or more… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …and product management and marketing. To accomplish this work, the Medicare Advantage Network Performance Manager will work closely with Provider ... your true colors to blue. What We Need The Medicare Advantage Network Performance Manager , as a...Management , Performance Measurement and Improvement, Health and Medical Management , and Medicare Markets. This role is… more
- The Cigna Group (Baltimore, MD)
- …at least 5-7+ years of progressive marketing communication and/or strategy experience. Medicare knowledge and management experience is highly preferred. As this ... Leads the development of customer onboarding and marketing plans for the Medicare Advantage customer journey. Communication plans will be multi-modal to include… more
- CareFirst (Baltimore, MD)
- …in the Medicare Advantage Bid process annually, the cost and utilization of all benefits to make adjustments annually, impact of marketing, sales, and ... (strategy, design, execution, and optimization) for products and plans in the Medicare , Medicaid, and Federal Employee Health Benefits categories. Leads the team in… more
- The Cigna Group (Bloomfield, CT)
- …Advisor - Medicare Part D/ Rx Service Operations** _Medication Therapy Management (MTM), Formulary, Drug Utilization Review (DUR), Opioid Edits, Pharmacy & ... creation, and closure. **Responsibilities** + Report to the Senior Manager of Medicare Part D Compliance -...Entities (FDR) + Act as a SME in the management of Corrective Action Plans (CAP) and other issue… more
- CVS Health (Buffalo Grove, IL)
- …team and external cross-functional teams to build consensus in formulary and utilization management decision-making process and continual enhancement of the ... supporting the creation and maintenance of the CVS Caremark's standard formularies, utilization management programs and other clinical programs assuring clinical… more
- The Cigna Group (Bloomfield, CT)
- …quality care is maintained. Provides clinical assessments, health education, and utilization management to members. Performs prospective, concurrent, and ... + **Job Description** + This position, the Nurse Case Manager Senior Analyst, through the case management ...**Position Scope:** + Manages/coordinates an active caseload of case management cases for Cigna Medicare . Uses clinical… more
- EM Key Solutions, Inc. (Eglin AFB, FL)
- Eglin AFB, FL, USA | Full Time Registered Nurse - Utilization Manager Onsite Position EM Key Solutions is seeking Registered Nurse (RN) for a full-time ... are not limited to the following: + Develops and implements a comprehensive Utilization Management plan/program in accordance with the facility's goals and… more
- EM Key Solutions, Inc. (Eglin AFB, FL)
- Eglin AFB, FL, USA | Hourly | Full Time Registered Nurse - Utilization Manager Location: Eglin Hospital at Eglin AFB, Fort Walton Beach, FL. Position Type- ... are not limited to, the following: + Develops and implements a comprehensive Utilization Management plan/program in accordance with the facility's goals and… more
- The Cigna Group (Houston, TX)
- …Provider Performance Lead Analyst's responsibilities include: + Supporting the development, management and oversight of the physician/ provider network in his/her ... limited to: preventative and quality outcome metrics, risk adjustment, medical cost management , etc. + Schedules, prepares for and participates in meetings with… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …and collaboratively to facilitate care based on the principles of care management . Facilitation is focused on assessing needs, identifying health care disparities, ... goals to promote optimal member outcomes. + Interpret and apply case management criteria, processes, policies, and regulatory standards to create, follow and… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …+ Comprehensive knowledge of utilization management , financial management that includes revenue cycle, Medicare , Medicaid, and commercial admission ... annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the market(s)… 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...performing UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare… more
- Elevance Health (Columbus, OH)
- …a check, or ask you for payment as part of consideration for employment. ** Utilization Manager Correspond Representative Sr (US)** + Job Family: CUS > Service ... + HI, KAPOLEI + IA, W DES MOINES + MA, WOBURN **Description** ** Utilization Manager Correspond Representative Sr** **Location: Remote** **Hours: 12pm-8:30am EST… more
- McLaren Health Care (Detroit, MI)
- **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the coordination of patient admission and continued stay ... observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure that… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …safe discharge coverage for all hospital units. + Participates in utilization management initiatives/opportunities for improvement through departmental committee ... accurately and in a timely manner. + Adheres to Medicare and Medicaid regulatory guidelines as it pertains to...Florida. + 3 years minimum experience in discharge planning, utilization management , or case management .… 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 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… 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
