- Your Behavioral Health (Torrance, CA)
- …with denial management , support appeal efforts with case summaries and clinical data Help identify trends in authorization delays or denials and provide input ... addiction treatment through Clear Behavioral Health and Neuro Wellness Spa. Our UR team plays a vital role in ensuring clients receive timely and medically necessary… more
- Campbell County Health (Gillette, WY)
- …focuses on integrating care management , social services, discharge planning, utilization review and post-hospital services to ensure clinical efficacy and ... functions of care coordination, facilitation of referrals, education, discharge planning, utilization management , and advocacy. ESSENTIAL FUNCTIONS * Completes… more
- Guthrie (Binghamton, NY)
- …to EPIC preference card modifications - Update preference cards based on feedback from clinical team leads and physicians to address changes to procedures or ... EPIC perioperative reporting related to key operational metrics, scheduling, and supply utilization . - Provide regular updates to management on key performance… more
- CVS Health (Columbus, OH)
- …promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team **Position Summary** The ... a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective...projects. Acting as the first point of contact for clinical issues, the Team Lead provides guidance… more
- Centene Corporation (Richmond, VA)
- …responsibility + Partner closely with claims and clinical and non- clinical Utilization Management (UM) team members to align processes and improve ... as a clinical professional on our Medical Management /Health Services team . Centene is a diversified,...fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure… more
- Carle Health (Champaign, IL)
- …Physician Advisor is responsible for conducting clinical case reviews referred by the Utilization Management Team , the Case Management Team , ... with the Clinical Denial Management team , the Utilization management team and the Clinical Denial Management team in defending payor… more
- Alameda Health System (San Leandro, CA)
- Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management + San Leandro, CA + John George Psychiatric Hospital + JGP Care Coordination + ... and AHS and Behavioral Health Department of Alameda County Utilization Plan. 2. Collaborates with the treatment team...identified fields in EHR. 17. Maintains current knowledge of clinical practice and Utilization Management … more
- CVS Health (Phoenix, AZ)
- …making a meaningful difference in the lives of patients? Join Mercy Care as a Utilization Management Clinical Consultant and become part of a mission-driven ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Waystar (Atlanta, GA)
- …domestic locations for client or business meets. Preferred Requirements: + Experience leading a Utilization Management team in an acute care setting + Active ... THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the...regulations as it pertains to patient status and care management + Works effectively on a multidisciplinary team… more
- Logan Health (Kalispell, MT)
- …Logan Health is looking for an RN to lead the way as our Manager of Clinical Documentation Integrity (CDI) & Utilization Review! This role is ideal for a ... manner + Partnering with the Chief Medical Officer on utilization review initiatives, length of stay management ,...RN experience to guide teams, support providers, and strengthen clinical documentation and utilization practices, we invite… more
- Martin's Point Health Care (Portland, ME)
- …since 2015. Position Summary The Supervisor is responsible for day-to-day operations of the utilization review clinical team , in the areas of authorization ... subject matter expert with specific focus on mentoring new team members, assisting with training and development, clinical...management experience in a managed care setting including utilization review + RN experience in a clinical… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to ... Bachelors degree preferred. + Minimum of three years of clinical experience required. Utilization Management ...within all jobs posted by the Excellus Talent Acquisition team . This decision is made on a case-by-case basis.… more
- CVS Health (Austin, TX)
- …of healthcare resources. Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of healthcare ... knowledge and expertise to enhance their understanding of utilization management principles and improve their clinical decision-making. Contributes to the… more
- Fallon Health (Worcester, MA)
- …Medical Officer will provide strategic leadership and oversight responsibility for the clinical and operational utilization management activities for all ... care, and staff across all product lines. **Responsibilities** ** Utilization Management :** + Oversees all administrative, operational and clinical functions… more
- CommonSpirit Health (Phoenix, AZ)
- …the senior leadership team , the System Vice President of Utilization management will contribute to high-level organizational decision-making, working closely ... with other executives and clinical leaders to align utilization ...UM effectiveness, and provide guidance and mentoring to UM team members, including physicians, clinical staff, and… more
- Centene Corporation (Madison, WI)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team . + Monitors and tracks UM resources to ... as a clinical professional on our Medical Management /Health Services team . Centene is a diversified,...performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve… more
- UNC Health Care (Morrisville, NC)
- …chairs, hospital leadership, and finance teams to harmonize utilization management practices, ensuring alignment with clinical and financial objectives. ... we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and...clinical system integration and a strong understanding of clinical and care management processes. + Demonstrated… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the CMHS. ... and the TRICARE Operations Manual (TOM) access to care standards for appropriate utilization of services. Perform utilization management /review for medical… more
- CVS Health (Austin, TX)
- …late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Utilizes clinical...an RN with preference for medical-surgical and ICU experience ( team is not accepting applicants whose only acute care… more
- UNC Health Care (Raleigh, NC)
- …clinical experience in a medical facility and/or comparable Utilization Management experience. **Knowledge/Skills/and Abilities Requirements:** **Job ... efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure patient needs are met and… more
