- Beth Israel Lahey Health (Plymouth, MA)
- …you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding UR and… more
- Beth Israel Lahey Health (Plymouth, MA)
- …is expanding its **Care Transitions Department** and seeking an experienced ** Manager of Utilization Review & Denials Management ** and ** Utilization ... CCM, ACM, or other case management certification preferred or in progress ** Manager - Utilization Review & Denials Management ** This role is ideal… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.Thisis a full-time role. *Purpose of this position: ... ) required or completed within three years of hire **Title:** * Utilization Review Manager * **Location:** *MN-Minneapolis-Downtown Campus* **Requisition… more
- Children's Mercy Kansas City (Kansas City, MO)
- …development of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, ... quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based...of hire + One of the following: American Case Management , Certified Case Manager required upon hire… more
- UNC Health Care (Smithfield, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders,… more
- Centene Corporation (Phoenix, AZ)
- … utilization management . + Oversees the behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines + Reviews ... Tempe and/or Tucson offices.** **Position Purpose:** Manages the behavioral health (BH) utilization review clinicians to ensure appropriate care to members.… more
- Community Health Systems (Franklin, TN)
- …discharge planning, and payer requirements. + Documents all utilization review activities in the hospital's case management software, including clinical ... Nursing preferred + 2-4 years of clinical experience in utilization review , case management , or...Compact State Licensure required + CCM - Certified Case Manager preferred or + Accredited Case Manager … more
- State of Indiana (Indianapolis, IN)
- …of Utilization Management Manager oversees the integration of utilization review , clinically appropriate care and risk management for the purpose ... Utilization Management Manager Date Posted: Aug 22, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling… more
- Behavioral Center of Michigan (Warren, MI)
- …skills to help educate the staff and physicians regarding charting. REPORTS TO: Utilization Review Lead/ Manager QUALIFICATIONS: + High School Diploma or ... Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex… more
- Virtua Health (Pennsauken, NJ)
- …UR Tech and AA to support UR and revenue cycle process.Position Responsibilities: Utilization Management * Utilizes Payer specific screening tools as a resource ... group and payers.Documentation* Appropriate and complete documentation of clinical review and denial management in the case...complete documentation of clinical review and denial management in the case management documentation system… more
- CVS Health (Charleston, WV)
- …**Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development and ... team maintains compliance and privacy practices. + Oversees the implementation of utilization management services for assigned area + Implements clinical… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership experience.… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- CVS Health (Little Rock, AR)
- …**Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development and ... Registered Nurse. + 3+ years of Managed Care experience. + 3+ years of Utilization Management experience. + 1+ year Leadership experience (formal or informal… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Prime Healthcare (Anaheim, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/218947/case- manager utilization - ... information visit www.westanaheimmedctr.com. Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility… more
- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the...care to MCC in response to physician order, or review of updated clinical information Acts as a resource… more
- Ochsner Health (Jefferson, LA)
- …This job manages expense management , vendor relationships, contract management , standardization and consolidation processes and utilization analysis. ... supply utilization improvements. + Good judgment, organizational and time management skills. + Consulting and group presentation skills. + Ability to travel… 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
- Baylor Scott & White Health (Dallas, TX)
- …to fit their needs. + Proficiency in discharge planning, setting case management referral standards, reviewing utilization , and categorizing levels of care. ... position type and/or level **Job Summary** + You will review patient cases for medical necessity and establish service...in Microsoft Office and medical documentation systems. + Case management certifications, such as Certified Case Manager ,… more
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