- Centene Corporation (Richmond, VA)
- …workflows, enhancing data accuracy, and driving efficiency to support timely and compliant claims outcomes. + Leads utilization management team on ... + Partner closely with claims and clinical and non-clinical Utilization Management (UM) team members to align processes and improve end-to-end handling of… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... Generous paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing… more
- Humana (Raleigh, NC)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- AIG (New York, NY)
- …are reimagining the way we help customers to manage risk. Join us as a Complex Claims Director to play your part in that transformation. It's an opportunity to ... assess liability and damages, recommend reserves, present large value cases to senior claims management , and attend mediations and trials. You will need… more
- Humana (Juneau, AK)
- …reports to Lead depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … 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 ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Evolent (Annapolis, MD)
- …LMSWs, LCSW, and LPCs, Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be ... the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as...prior authorization requests and/or relevant health care experience in claims or appeal & grievances is required. + Ability… more
- Guthrie (Cortland, NY)
- Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and the Robert ... Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of...requirements and to assist in ensuring generation of clean claims in a timely manner + Securing authorization as… more
- South Middlesex Opportunity Council (Framingham, MA)
- …casual Working Conditions: As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact with ... children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. Candidates must… more
- US Tech Solutions (Columbia, SC)
- …and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims ... determinations. Identifies and makes referrals to appropriate staff (Medical Director , Case Manager, Preventive Services, Subrogation, Quality of Care Referrals,… more
- Integra Partners (Troy, MI)
- … Director ) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES + ... codes + Verify eligibility and claim history in proprietary claims platform + Verify all necessary documentation has been...external sources + Other duties as assigned by UM Director + Strong organizational skills, ability to adapt quickly… more
- Martin's Point Health Care (Portland, ME)
- …experience as an RN, preferably in a hospital setting + 2+ years of utilization management experience in a health plan UM department Required License(s) and/or ... performs medical necessity reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate… more
- Commonwealth Care Alliance (Boston, MA)
- …considered at this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical ... medical claims adjudication, clinical coding reviews for claims , settlement, claims auditing and/or utilization...and Analytics + Direct and relevant experience with HCFA/UB-04 claims management , coding rules and guidelines, and… more
- The County of Los Angeles (Los Angeles, CA)
- NURSING DIRECTOR , ADMINISTRATION ( Director , Workforce Management and Operations) Print ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/3110377) Apply NURSING DIRECTOR , ADMINISTRATION ( Director , Workforce Management and Operations) Salary $163,996.80… more
- Mount Sinai Health System (New York, NY)
- …: + Active RN license in the state of employment required + Certification in Case Management (CCM, ACM) or Utilization Management preferred. + 7+ years of ... **Job Description** ** Director Pre Appeals Management -HSO Appeals ...experience in clinical acute clinical, utilization management , appeals management or… more
- Prime Healthcare (Ontario, CA)
- …(LVN) license. + Minimum (2) two years of experience in acute hospital case management or equivalent. + Utilization Management experience required. + ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236094/ utilization -review-nurse-lvn/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
- University of Southern California (Los Angeles, CA)
- The Senior Director , Integrated Risk Management , is responsible for designing and executing the Keck Medicine of USC Office of Integrated Risk Management at ... mitigate and monitor the Health System's Clinical Risk. Senior Director will facilitate the identification of risk management...Director will coordinate with the Executive Administrator, Senior Director of Claims , Director of… more
- OneMain Financial (New York, NY)
- …digital capabilities. + **Leverage data and analytics** to measure funnel performance, claims utilization , and operational efficiency; use insights to drive ... and financial wellness. **About the Role** We are seeking an **Associate Director ,** **Product Management - Insurance** to lead the end-to-end experience… more
- Centene Corporation (Salem, OR)
- …+ Must be licensed in Oregon + American Board Certification + Utilization Management experience and knowledge of quality accreditation standards highly ... preferred **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management...business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality… more
- Centene Corporation (Olympia, WA)
- …+ American Board certified in Child or Addiction Psychiatry, preferred + Utilization Management experience and knowledge of quality accreditation standards. + ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. +… more