- LA Care Health Plan (Los Angeles, CA)
- …work/licensure. The Supervisor is a subject matter expert (SME) in Care /Case/ Utilization Management and supporting regulations, policies, protocols, and ... Supervisor , Utilization Management RN... Supervisor , Utilization Management RN Job Category: Clinical... experience. Minimum of 2 years of experience in Case/ Care / Utilization Management in an acute… more
- Centene Corporation (Madison, WI)
- …to performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH care member issues related to BH ... ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization … more
- Centene Corporation (Atlanta, GA)
- …performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues + Maintains ... knowledge of regulations, accreditation standards, and industry best practices related to utilization management + Works with utilization management team… more
- SSM Health (MO)
- … of daily operations within assigned region(s) or ministries related to the Utilization Management (UM) Review area under the direction of managers. Interacts ... Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES + Responsible for daily Utilization Management (UM) operations, which includes referrals, medical… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. In this role as a Utilization Review Supervisor within our utilization department you would be responsible for ... nurses, ensuring compliance with clinical regulatory standards, and enhancing the overall utilization review process to optimize patient care and manage… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... of health care services and compliance with UR policies/procedures, as well...standards and federal/state regulations and general principles relating to utilization review. + Computer skills, including Microsoft Office programs.… more
- UCLA Health (Los Angeles, CA)
- …Advantage team, you will be responsible for assisting with the day-to-day management of the UM department and coordinators. This will involve coordinating staff ... staff in a healthcare environment + Two or more years of managed care or health plan experience preferred + Experience processing ambulatory commercial, Medicare Fee… more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical ... and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role in ensuring CCA meets CMS… more
- Hartford HealthCare (Wethersfield, CT)
- …_* The Clinical Resource Management Associate is an integral part of the Care Management team. The Clinical Resource Management Associate's focus is on ... programs and other common practices across the system. Integrated Care Partners (ICP) is a physician-led, clinically integrated health...providing support and coordination of utilization management services for the … more
- Hartford HealthCare (Torrington, CT)
- …Summary* Under the Direction of the Inpatient Nurse Director & Social Work Supervisor , the Inpatient Psychiatric Utilization Review Social Worker will work ... collaboratively with the IP Psychiatry Patient Care Team to assure Utilization Review activities...that may include: individual, group, & family therapy; case management , interdisciplinary collaboration for care transition needs,… more
- Commonwealth Care Alliance (Boston, MA)
- …and facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical ... **Why This Role is Important to Us:** Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is...authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role… more
- Insight Global (Philadelphia, PA)
- …their Care management team. Under the direction of a designated Care Management and Coordination Supervisor , performs telephonic or onsite review of ... to work from home 3+ years of case management and utilization management experience Post acute Care experience Discharge planning and post acute… more
- BayCare Health System (Cotton Plant, AR)
- … Care or Emergency Service **Facility:** BayCare Health System, Utilization and Denials Mgmt-MPH **Location:** **Morton Plant** **Status:** **Part Time, Exempt: ... area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians.… more
- CVS Health (New Albany, OH)
- …of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at ... accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. **Position Summary** **Must reside within… more
- CVS Health (Tallahassee, FL)
- …working in community based mental health service like Targeted Care Management , Psychosocial Rehabilitation, or related utilization management experience ... purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our...UM clinician will work in conjunction with the Clinical Supervisor and Medical Directors to facilitate optimal care… more
- Hackensack Meridian Health (Edison, NJ)
- …serve as a leader of positive change. The role integrates and coordinates utilization management , care coordination, discharge planning functions and ... improvement activities for all care managers. The ** Supervisor , Care Management ** is accountable...setting. + Familiar with hospital resources, community resources, and/or resource/ utilization management . + Care coordination,… more
- AdventHealth (Orlando, FL)
- …than 32,000 inpatients and 125,000 outpatients each year **The role you'll contribute:** **The Care Management Supervisor is under the general leadership of ... supervision of team members in the Care Management department.** **The Care Management Supervisor is responsible for the daily front line operations… more
- AdventHealth (Altamonte Springs, FL)
- … with visionary leadership and world-class resources **The role you'll contribute:** **The Care Management Supervisor is under the general leadership of ... the Care Management department.** **The Care Management Supervisor is responsible...schedule minimizes unscheduled absences Plans job responsibilities for maximum utilization of staff Resolves daily staffing issues **The expertise… more
- Praxis Health (OR)
- …Praxis Healthis seeking a dedicated and compassionate Registered Nurse to serve as aRemote Care Management Supervisor . In this role, you will oversee an ... management processes to engage high risk patients, reduce utilization and improve health outcomes + Directly engage with...healthcare is done right! General Physical Requirements The Remote Care Management Supervisor role requires… more
- Actalent (Madison, WI)
- Care Management Program Supervisor Job Description Responsibilities: + Team Oversight: Supervise and support a team of case managers, ensuring they provide ... clients. + Reporting: Prepare and analyze reports on case management activities, outcomes, and service utilization to...strategic planning and decision-making. Qualifications + 3 years of Care Management + Experience working with elderly… more