- Marion County (Salem, OR)
- …& Human Services is looking for an adaptable, collaborative, and experienced Program Manager who will assist the department in achieving its mission: To create a ... to the following Program Development & ManagementProvide program development and management /oversight of a diverse group of programs and teams. Program oversight… more
- The University of Vermont Health Network (Elizabethtown, NY)
- …rules, and regulations, clinical practice guidelines, and quality issues related to utilization management with application for appeals and denials management ... nurse manager who is responsible for conducting inpatient Care Management ; and Swing Bed admission/recruitment process consistent with the goals and objectives… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team ... of UM coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and manage various...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- LA Care Health Plan (Los Angeles, CA)
- Product Solutions Manager III ( Medicare ) Job Category: Administrative, HR, Business Professionals Department: Medicare Product Location: Los Angeles, CA, US, ... safety net required to achieve that purpose. Job Summary The Product Solutions Manager III is responsible for assisting the product leadership team within the… more
- Humana (Columbus, OH)
- …help us put health first** Humana Healthy Horizons in Virginia is seeking a Manager , Utilization Management (Behavioral Health) who will utilize their ... communication of behavioral health services and/or benefit administration determinations. The Manager , Utilization Management (Behavioral Health) applies a… more
- CareFirst (Baltimore, MD)
- …in the Medicare Advantage Bid process annually, the cost and utilization of all benefits to make adjustments annually, impact of marketing, sales, and ... (strategy, design, execution, and optimization) for products and plans in the Medicare , Medicaid, and Federal Employee Health Benefits categories. Leads the team in… more
- The Cigna Group (Bloomfield, CT)
- …quality care is maintained. Provides clinical assessments, health education, and utilization management to members. Performs prospective, concurrent, and ... and specialist appointment scheduling. + Provide clinical assessments, health education, and utilization management to customers, as needed. + Initiate contact… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …+ Comprehensive knowledge of utilization management , financial management that includes revenue cycle, Medicare , Medicaid, and commercial admission ... annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the market(s)… more
- Guidehouse (Gardena, CA)
- …**What You Will Do** **:** The **Insurance Patient Account Representative - Medicare Emphasis** is an extension of a client's business office staff. Representatives ... from home._** **_Questions regarding this position, you may contact Chris Rivera ( Manager , Talent Acquisition) at ###_** **Essential Job Functions** + Medicare … more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will...performing UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will...performing UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare… more
- The Cigna Group (Tucson, AZ)
- Pima County based - Medicare Provider Performance Enablement (PPE) Senior Analyst provides broad support to Sr. Supervisor, Sr. Manager , Director, and Other ... interaction with PPE staff as well as other Cigna Medicare departments. Position is exposed to all aspects of...provider demographic records by validating and submitting all data management requests for completion. + Prepare for and participate… more
- The Cigna Group (Baltimore, MD)
- …provider group improvement plans autonomously, with expert-level technical support from manager . + Knowledge of quality and affordability metrics and tools; ... effective communication to inform external partners. + Supporting the development, management and oversight of the physician/ provider network in his/her assigned… more
- McLaren Health Care (Detroit, MI)
- **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the coordination of patient admission and continued stay ... observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure that… more
- Dignity Health (Rancho Cordova, CA)
- …home.** **Position Summary:** Under the guidance and supervision of the department Manager /Director, the Supervisor of Utilization Management is responsible ... Medicare Guidelines, InterQual, Health Plan Benefit Interpretation Guidelines and Medical Management Policies, and DHMF Utilization Management guidelines… more
- Hackensack Meridian Health (Hackensack, NJ)
- …a. Provides direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight for accurate patient ... vs. Inpatient c. Liaison to the Medical Staff supporting Utilization Management Committee processes d. Hospital Based...documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Manager Utilization Management Nursing utilizes clinical nursing skills to support ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
- InnovaCare (San Juan, PR)
- …to bringing passion and customer focus to the business. The Care Manager is responsible to assess all referred cases, plan, implement, perform interventions, ... term. Assumes leadership across the continuum of care and promotes effective utilization of resources to obtain cost-effective outcomes. Coordinates care across care… more
- Bon Secours Mercy Health (Greenville, SC)
- …review experience. + High level of clinical skills required. + Utilization management experience preferred. + Familiar with Medicare MS-DRGs and Medicare ... educational resources if gaps exist. Educate hospital and medical staff regarding Care Management , Utilization Review and other current related issues toward the… more
- Alameda Health System (Oakland, CA)
- …the continuum. -Manages and assumes responsibility for day-to-day operations of utilization management , care coordination and discharge planning activities. ... Manager , Care Management + Oakland, CA...committees and in conjunction with the Director of Care Management identifies utilization issues affecting the quality… more
