- Commonwealth Care Alliance (Boston, MA)
- … Mgmt - Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. - Ensures that utilization management processes are integrated with care management … more
- Commonwealth Care Alliance (Boston, MA)
- …& Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the ... and facilities under the provisions of CCA's benefits plan. The Manager, Utilization Management is responsible for overseeing and managing the daily operation of… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS… more
- ERP International (Macdill AFB, FL)
- …International is seeking a **Registered** **Nurse (RN)** for a Full-Time position in ** Utilization Management ** at MacDill AFB, FL. Apply online today and ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- ERP International (Vandenberg AFB, CA)
- **Overview** ERP International is seeking a full-time **Registered Nurse (RN) Utilization Management ** for a temporary contract position in support of the30th ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- InterDent (Portland, OR)
- …Develop, implement, and monitor clinical guidelines, quality improvement initiatives, and utilization management processes to enhance patient outcomes and ... best practices Lead hiring, onboarding, training, mentoring, and performance management of dentists and hygienists Evaluate clinical performance and...optimize resource utilization . Lead efforts in achieving quality performance targets, including… more
- Alameda Health System (San Leandro, CA)
- … Management provides Care Coordination, Compliance, Transition Coordination, and Utilization Management . **DUTIES & ESSENTIAL JOB FUNCTIONS** NOTE:The ... clinical background. Within the last 3 years, experience in Case Management in an acute setting or utilization review at a medical group or health plan. Required… more
- Bryan Health (Lincoln, NE)
- …to appropriate provider. *Maintains awareness of financial reimbursement methodology, utilization management , payer/reimbursement practices and regulations and ... (2) years recent clinical experience required. Prior care coordination and/or utilization management experience preferred. Basic Life Support (CPR) certification… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …assist in implementing and administering these programs along with supporting drug utilization management strategies and programs for Pharmacy, Medical Services, ... lines of business through research, analyses, and administration of clinical drug utilization management programs. + Provide clinical drug utilization … more
- Skaggs Community Hospital Association (Branson, MO)
- …to other team members. Excellent communication skills, leadership ability, time management , and problem solving skills required. * Job Requirements ◦ Education ... the institution. ▪ Working knowledge in human relations, customer service, inventory management . ▪ Ability to work with multiple people while meeting numerous… more
- Providence Little Company of Mary Medical Center San Pedro-… (San Pedro, CA)
- …ensure timely, efficient, and effective discharge planning and transitions. Supports utilization management and ensures compliance with payer guidelines. ... Client Name Providence Little Company of Mary Medical Center San Pedro- Case Management Job Type Travel Offering Nursing Profession RN Specialty Case Manager Job ID… more
- Daiichi Sankyo, Inc. (Bernards, NJ)
- …around rare diseases and immune disorders. Job Summary: The Director of Data Management (DM) Reporting provides leadership in Data Management Operations for the ... data protection, operational metrics, and clinical trial quality and risk management reporting requirements that adhere to programming standards and specifications… more
- Luke Staffing (Yigo, GU)
- …of clinical nursing experience is required. One year of previous experience in Utilization Management is required. Full time employment in a nursing field ... requirements of this position, it must be directly related to referral/ utilization management . + **Licensure:** Current, full, active, and unrestricted… more
- HealthCare Support (Fort Worth, TX)
- …for Remote Behavioral Medical Director: Provide clinical leadership for utilization management , cost containment, and quality improvement programs ... Director Medical Doctor or Doctor of Osteopathy Active Texas Medical License Utilization Management experience and knowledge of quality accreditation standards… more
- CoxHealth (Lake Spring, MO)
- …and collaboration with physicians, nursing, and ancillary staff including Health Information Management coders is key to the success of this position. This position ... team regarding proper clinical documentation utilizing approved guidelines. Understand and utilization of ICD-10-CM and PCS coding assignment and follow Official… more
- Commonwealth Care Alliance (Boston, MA)
- …Work collaboratively with internal departments-including Clinical Operations, Contracting, Network Management , Utilization Management , and Business ... Abilities & Language (nice to have):** + Familiarity with care management and utilization management systems and workflows for populations with complex… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …regulatory requirements, and ensures these requirements are accurately followed and Utilization Management (UM) decision determinations and timeliness standards ... (REQUIRED) + Three (3) years of clinical experience (REQUIRED) + Utilization Management experience + Experience working in the health plan industry **Premera… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management - Serve as the primary relationship manager and point of contact… more
- Merck & Co. (Rahway, NJ)
- …public and private realms.Leverage data in conducting analyses and studies on space utilization , efficiency, and needs to optimize the allocation and use of existing ... are used to critically leverage occupancy data like headcount, attendance, and utilization to ensure alignment with workspace design requirements and real estate… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …regulatory requirements, and ensures these requirements are accurately followed and Utilization Management (UM) decision determinations and timeliness standards ... law **(Required)** + Three (3) years of clinical experience ( **Required)** + Utilization Management experience (Preferred) + Experience working in the health… more
