- Humana (Columbus, OH)
- …put health first** Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical skills to ... behavioral health services and/or benefit administration determinations. The Manager, Utilization Management (Behavioral Health) applies a Person-Centered… more
- Centene Corporation (Oklahoma City, OK)
- … review clinicians to ensure appropriate care to members. Manages BH utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages behavioral health (BH) utilization review clinicians and ensures compliance with applicable… more
- Centene Corporation (Columbia, SC)
- …benefits including a fresh perspective on workplace flexibility. + Collaborates with utilization management team to resolve complex care member issues + ... knowledge of regulations, accreditation standards, and industry best practices related to utilization management + Works with utilization management team… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the market(s) ... development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the CommonSpirit Health Care Coordination… more
- Sharp HealthCare (San Diego, CA)
- …the episode of care and supports other members of the System Centralized Utilization Management team to ensure final status reconciliation. This position ensures ... Qualifications** + Bachelor's Degree in a health related field + 3 Years Utilization Management or case management within a hospital or payer setting +… more
- WellSpan Health (York, PA)
- Utilization Management Nurse (RN) - Case Management - Day (Temporary) Location: WellSpan Health, York, PA Schedule: Full Time Sign-On Bonus Eligible ... effective and quality health care. Provides leadership in the integration of utilization management principles throughout the System. Responsible for screening… more
- AmeriHealth Caritas (Newark, DE)
- ** Utilization Management Plan Oversight Manager** Location: Newark, DE Primary Job Function: Medical Management ID**: 34207 **Job Brief** Qualified ... UM DE, and serves as SME for clinical components DE Medicaid Utilization Management Program. Works in close collaboration with all departments to achieve… more
- Hackensack Meridian Health (Hackensack, NJ)
- …mission to transform healthcare and serve as a leader of positive change. The Case Management Care Coordinator, Utilization Management is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- CVS Health (Raleigh, NC)
- …deliver solutions to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote and ... dedicated team supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document… more
- Universal Health Services (Sacramento, CA)
- Responsibilities Sierra Vista Hospital is seeking a full-time Utilization Management Coordinator (MSW, MFT, MA, RN) for the Utilization Management ... expertise to those suffering from emotional, behavioral and addiction problems. The Utilization Management Coordinator (MSW, MFT, MA, RN) is responsible for… more
- CVS Health (Columbus, OH)
- …to make health care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is fully remote and ... employee can live in any state. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all… more
- Hackensack Meridian Health (Perth Amboy, NJ)
- …mission to transform healthcare and serve as a leader of positive change. The Care Management , Care Coordinator, Utilization Management is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- McLaren Health Care (Detroit, MI)
- **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm** **Shift: Days** **Scheduled Bi-Weekly Hours: 40** **Position Summary:** Responsible ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations of the… more
- McLaren Health Care (Indianapolis, IN)
- We are looking for a Utilization Management , RN - IN to join us in leading our organization forward. McLaren Integrated HMO Group (MIG), a division of McLaren ... Inc. at https://www.mdwise.org/ **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- Universal Health Services (Chicago, IL)
- …continued treatment based on payer's criteria and in accordance with the hospital wide Utilization Management Plan. Serves as liaison to 3rd and 4th party ... physician reviews with payers as required. Maintains all records/data pertaining to the Utilization Management Program. Actively participates in Utilization … more
- Universal Health Services (San Antonio, TX)
- Responsibilities Position Summary : The Utilization Management Supervisor is responsible for planning, organizing, and managing daily operations of the ... Utilization Management team. The Supervisor duties include but are not limited to ensuring positive communication amongst treatment team members, modeling Service… 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 ... safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Hackensack Meridian Health (Edison, NJ)
- **Overview** The Care Management , Care Coordinator, Utilization Management is a member of the healthcare team and is responsible for coordinating, ... patient?s treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Compliance Utilization Management Nurse 2 reviews utilization management activities and ... holidays on a rotating schedule. (about 2 holidays per year) The Compliance Utilization Management Nurse 2 ensures mandatory reporting completed. Conducts and… more
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