- 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: ... the safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day… more
- Centene Corporation (Atlanta, GA)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. **(Must reside in Georgia).** + Monitors and ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Centene Corporation (Tallahassee, FL)
- …**Centene is hiring!** **We're looking for two remote Supervisors of Behavioral Health Utilization Management to support our Florida market. In this leadership ... to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization … more
- Dignity Health (Rancho Cordova, CA)
- …Summary:** Under the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable ... sets (Medicare Guidelines InterQual Health Plan Benefit Interpretation Guidelines and Medical Management Policies and DHMF Utilization Management guidelines… more
- Dignity Health (Bakersfield, CA)
- …This role will require Admin on-call on weekends/holidays.** **Position Summary:** The Supervisor of Utilization Management Inpatient Clinical will oversee ... clinical inpatient UM staff, ensuring they effectively perform utilization management (UM) reviews for inpatient cases.... reviews and that care is delivered efficiently. The Supervisor will also ensure adherence to internal and external… more
- Providence (Everett, WA)
- **Description** The Supervisor for Utilization Management provides a key role in leading, facilitating and managing the hospital utilization ... upon hire + Previous healthcare administration and/or delivery of healthcare services + Utilization Management /Review. + Experience related to a wide variety of… more
- AmeriHealth Caritas (Dover, DE)
- …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon to: + Conduct concurrent reviews… more
- WellSpan Health (York, PA)
- …peer cases for need of retrospective external appeal-and funnel those cases to the Supervisor of Utilization Management for expedition. + Reviews cases ... Management staff. **Duties and Responsibilities** **Essential Functions:** + Renders utilization management determination in accordance with State and Federal… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print... Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 - $167,136.48 Annually Location Los… more
- Spectrum Billing Solutions (Skokie, IL)
- …cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing team. The UR Supervisor ... and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for treatment… 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...requirements are met + Additional duties as requested by supervisor + Maintains knowledge of CMS, State and NCQA… 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, ... Emergency Department) - 3+ years of experience in case management - 3+ years of experience in utilization...on a rotating basis with other managers when on-call Supervisor is unavailable. + Develops and oversees relationships and… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse, Revenue Integrity & Utilization Management Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is ... to be named six times by Forbes as a Best Employer. Position Summary: The RN Utilization Management I will perform utilization management functions to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …encourage you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and ... attendance is expected and required. + Performs other functions as assigned by management . Level II (in addition to Level I Accountabilities) + Assists and performs… more
- Helio Health Inc. (Syracuse, NY)
- …Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management ... track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our Inpatient,… more
- St Joseph's Addiction Treatment & Recovery Centers (Saranac Lake, NY)
- …Location: Inpatient Facility - Saranac Lake, NY Position: Full-time Utilization Review Specialist Shift/schedule: Monday-Friday, 8:00am-4:30pm Pay Range: $22.00/hour ... and coordinate account card reimbursements, if necessary. + Support behavioral utilization activities, aligning with agency policies to promote optimal client care… more
- AmeriHealth Caritas (Philadelphia, PA)
- …pediatric patients in a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization. + Experience ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Ellis Medicine (Schenectady, NY)
- + The Supervisor of Case Management and Social Work (CMSW) assists with the daily operations of the Department. This person can assist with the hiring and ... of stay (LOS) and cost per case through resource management . + The Supervisor of CMSWS is...CMSWS assist with providing the link between compliance, clinical management , patient progression, gathering and reporting of utilization… more
- Kaleida Health (Williamsville, NY)
- **Patient Management Supervisor ** **Location:** Millard Fillmore Suburban **Location of Job** : US:NY:Williamsville **Work Type** : Part-Time **Shift 1** **Job ... equity and inclusion where diversity is valued and celebrated!_ **Position** Patient Management Supervisor **Location** US:NY:Williamsville | Management |… more
- AdventHealth (Orlando, FL)
- …601 E Rollins St, Orlando, FL 32803 **The role you'll contribute:** The Care Management Supervisor is under the general leadership of the Care Management ... and performing the daily operations and supervision of team members in the Care Management department. The Care Management Supervisor is responsible for the… more