- Daiichi Sankyo, Inc. (Bernards, NJ)
- …develop a cross-functional, integrated study plan and create initial study budget. Review study feasibility assessments provided by the CRO(s), lead the CRO ... risk related plans and ensure study team adherence and utilization . Be aware of and be able to predict...for resource management within their therapeutic area. Management requires review of resources against development pipeline to identify areas… more
- Merck & Co. (Durham, NC)
- …Drug Product Operations Manager Accountability - Project SupportFirst-line operations supervisor with a team of individual contributor production direct ... culture by reducing waste and constantly driving continuous improvement-- Review and approve compliance documents, as per procedures or need.Supply/Support… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …directly manages 8 to 13 workers + This role reports to this job: DIRECTOR, UTILIZATION REVIEW ;MANAGER, UTILIZATION REVIEW + Necessary Contacts: In order ... services are provided is required + Certification in Professional Coding, Utilization Review , Utilization Management, Quality Review , Case Management… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our...implemented for compliance, as needed. + As a unit supervisor at the LA General Medical Center: + Has… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing team. The UR ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Centene Corporation (Jefferson City, MO)
- …flexibility. **_ Remote Role _** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team to ... ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence to… more
- Sedgwick Government Solutions (Charleston, SC)
- Job Details Utilization Review Case Manager RN (Remote) 2025-1434 Charleston, SC, USA Medical Services Full Time Description ** Utilization Review Case ... and support through our highly skilled team of home-based Utilization Review Case Managers. Are you looking...appropriate department. + Meets productivity goals as outlined by supervisor . + Maintains privacy, as per Program guidelines, within… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The position of Senior Utilization Review Manager is ... responsible for the oversight of third-party payer utilization review (UR), denial management (DM) processes...to the additional special projects. Working with the UR Manager/ Supervisor (s), a Senior manager functions as a subject matter… more
- AmeriHealth Caritas (Washington, DC)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
- St Joseph's Addiction Treatment & Recovery Centers (Saranac Lake, NY)
- …Centers Location: Inpatient Facility - Saranac Lake, NY Position: Full-time Utilization Review Specialist Shift/schedule: Monday-Friday, 8:00am-4:30pm Pay Range: ... , supporting the agency's mission and client care quality. Department Utilization Review Employment Type Full-Time Minimum Experience Mid-level Compensation… more
- BJC HealthCare (St. Louis, MO)
- …nurse experience performing care for hospitalized patients. + 2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity ... quality of medical services provided by the medical team. Ensure appropriate utilization , which includes the evaluation of potential under and over- utilization … more
- AmeriHealth Caritas (Philadelphia, PA)
- …us at www.amerihealthcaritas.com. **Responsibilities:** Under the direction of the unit Supervisor , the Clinical Care Reviewer- Shift Care is responsible for ... the case is presented to the Medical Director for medical necessity review . Upon approval of services, responsibilities include timely notification and education to… more
- Covenant Health Inc. (Knoxville, TN)
- …meetings between physicians and payors as applicable. + Completes daily work lists for utilization review meeting the time frames set forth by Covenant Health. + ... Overview Registered Nurse, Revenue Integrity & Utilization Management Full Time, 80 Hours Per Pay...to non-clinical precertification staff. + Assists with delayed claims review to determine appropriate number of observation hours as… 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
- Commonwealth Care Alliance (Boston, MA)
- …service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Sharp HealthCare (San Diego, CA)
- …Do** The UM Care Coordinator, under the direct supervision of the Supervisor , Utilization Management Care Coordinators, prepares referral requests for outpatient ... care, managed care, as it related to the position.Bring to attention of the Supervisor , Utilization Management Care Coordinators, and UM Manager, areas of UM… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. ... + Assist with all Blue Card Claims escalations. + Assist management with the review and creation of desk level procedures, acting as a subject matter expert for… more
- CN (Geismar, LA)
- …because the work we do matters. Join us! **Job Summary** The Transportation Supervisor is an entry-level front line supervisor position responsible for meeting ... and in compliance with governing regulations and CN's operating rules. The Transportation Supervisor may also be an on-call position that reports to remote locations… more
- HCA Healthcare (Asheville, NC)
- …satisfaction and personal growth, we encourage you to apply for our Supervisor Pharmacy Medication Reconciliation opening. We promptly review all applications. ... integrity. We care like family! Jump-start your career as a(an) Supervisor Pharmacy Medication Reconciliation today with Mission Hospital. Benefits Mission Hospital,… more
