- Commonwealth Care Alliance (Boston, MA)
- …services, procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director of… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time ... **Shift:** Day **Location** : Holy Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management , you will be the key to ensuring patients… more
- HCA Healthcare (Richmond, VA)
- …Do you want to join an organization that invests in you as a(an) Case Manager Behavioral Utilization Management ? At Chippenham Hospital, you come first. HCA ... the opportunity to make a difference. We are looking for a dedicated Case Manager Behavioral Utilization Management like you to be a part of our team. **Job… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... compliance reviews as needed. + Continuously monitors regulatory requirements for Utilization Management . + Attends Mandatory Education programs required by… more
- Prime Healthcare (National City, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/205657/case- manager utilization - management ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
- Evolent (Hartford, CT)
- …contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager , Utilization ... Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for processing… more
- Catholic Health Initiatives (Houston, TX)
- **Responsibilities** The Utilization Management (UM) Manager is responsible for managing day-to-day UM operations within the markets, focusing on effective ... medical necessity determinations; processes appeals and reconsiderations. Act as a working manager within Utilization Management , performing essential duties… more
- Alameda Health System (Oakland, CA)
- …requirements. 16. Participate in orientation of fresh staff as requested by the Manager of Utilization Management . 17. Maintains knowledge of current ... System Utilization Management SUM Utilization ...in the State of California Preferred Licenses/Certifications: Certified Case Manager (CCM) or Accredited Case Manager (ACM)… more
- Amazon (Seattle, WA)
- …Business Intelligence, and more in support of developing and improving DC supply management software and tooling. You will use your strong analytic and quantitative ... by others, this job is for you! Key job responsibilities - Optimize utilization of electrical distribution systems across AWS data center fleet - Partner with… more
- Covenant Health (Lewiston, ME)
- …Summary The UR Case Manager conducts medical necessity reviews per the Utilization Management (UM) plan for patients housed on a nursing unit, including ... experience in utilization review, discharge planning, social work case management , or Utilization Manager experience preferred. + Certification as CCM or… more
- Pacific Medical Centers (Seattle, WA)
- …cost effective, appropriate utilization of health care resource. UM Nurse Case Manager perform utilization management of services and coordinates the ... Washington Registered Nurse License. + 5 years Clinical experience. + Utilization review/case management . **Preferred Qualifications:** + Bachelor's Degree in… more
- Trinity Health (Chelsea, MI)
- …Full time **Shift:** Rotating Shift **Description:** **Registered Nurse** **Case Manager ** **Department:** Utilization Management **Location:** Chelsea, ... **Position Purpose:** Exceptional opportunity for a Registered Nurse Case Manager to support our vision and serve with us...use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all members of… more
- Stanford Health Care (Palo Alto, CA)
- …practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, ... experience as an RN (in an Emergency Department) - 3+ years of experience in case management - 3+ years of experience in utilization review Why work at Stanford… more
- Tufts Medicine (Burlington, MA)
- …with the coordination of the Utilization Management Committee. The Utilization Management Operations Manager follows the system's Utilization ... to Utilization Review departments and UM vendor management . The UM Operations Manager is responsible...the Utilization Management Plan and assisting… more
- Penn Medicine (Philadelphia, PA)
- …their critical thinking skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, ... hospice, community resources, transportation, and quality data collection and risk management referral. + Responsibilities: Utilization management … more
- Amergis (Orange, CA)
- …Case Manager to help support a health insurance agency! The Medical Case Manager (BHI Utilization Management ) will be responsible for reviewing and ... as those listed above may also be qualifying. Preferred Qualifications: + Utilization management reviewer experience. + Managed care experience. + Behavioral… more
- Beth Israel Lahey Health (Burlington, MA)
- …of three years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ... a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:**...to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and… more
- Helio Health Inc. (Syracuse, NY)
- …to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our ... Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management… more