- 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
- Centene Corporation (New York, NY)
- …an active New York State RN license.** **Inpatient Utilization Management ** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials … more
- UNC Health Care (Morrisville, NC)
- …the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible ... for designing, implementing, and standardizing utilization management functions across a large healthcare...Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate… more
- AmeriHealth Caritas (Lafayette, LA)
- **Role Overview:** Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient ... and making determinations based on clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… more
- Access Dubuque (Dubuque, IA)
- …Utilization Management Assistant answers first level calls in Utilization Review for HealthCheck360 participants. They will evaluate certification ... Utilization Management CNA **Cottingham & Butler/... Utilization Management CNA **Cottingham & Butler/ SISCO** 1 Positions...will also triage the call to determine if a Utilization Review Nurse is needed to complete… more
- UPMC (Pittsburgh, PA)
- …and full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including ... MD or DO for a fully remote Medical Director, Utilization Management role. The Medical Director, ...and potential quality of care concerns. + Provide expedited review and determination of medically pressing issues in accordance… more
- McLaren Health Care (Port Huron, MI)
- **Department:** Utilization Review **Daily Work Times:** 8:00am-4:30pm **Hours Per Pay Period:** 40 **Position Summary:** Responsible for determining the ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- UPMC (Pittsburgh, PA)
- …Life Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, ... The Medical Director, Utilization Management is responsible for assuring...and potential quality of care concerns. + Provide expedited review and determination of medically pressing issues in accordance… more
- Commonwealth Care Alliance (Boston, MA)
- …and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating care for members ... of the member's benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer is part of a highly dedicated and motivated team of… more
- AnMed Health (Anderson, SC)
- …, continued stay/concurrent review , retrospective review , bed status management , resource utilization management , regulatory compliance, and related ... issues. Duties & Responsibilities + Performs assigned utilization management functions daily: initial, concurrent and retrospective review of the… more
- University of Michigan (Ann Arbor, MI)
- Utilization Management Assistant (Patient Services Intermediate) Apply Now **How to Apply** A cover letter is required for consideration for this position and ... authorization numbers and approval days/dates into the appropriate software system for utilization management and electronic medical records. 5. Fax clinical… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- Humana (Lincoln, NE)
- …MDS Coordinator or discharge planner in an acute care setting + Previous experience in utilization management / utilization review for a health plan or ... of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Intermountain Health (Las Vegas, NV)
- …The Manager of Care Management I leads and collaborates with care management operations across utilization review , acute and emergency department care, ... Qualifications** + Previous management experience in hospital care management , utilization review , ambulatory care management , ambulatory … more
- Brighton Health Plan Solutions, LLC (NC)
- …Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance ... pace and changing environment- flexibility in assignment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical… more
- CVS Health (Columbus, OH)
- …Microsoft Office Applications (Outlook, Teams, Excel) **Preferred Qualifications** - Utilization review experience preferred - Knowledge of Medicare/Medicaid ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** - 2+ years of… more
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