- Hartford HealthCare (Wethersfield, CT)
- …is *your moment.* **Job:** **Administrative* **Organization:** **Hartford HealthCare Corp.* **Title:** * Utilization Management Assoc / Clinical Resource ... Resource Management Associate's focus is on providing support and coordination of utilization management services for the utilization management … more
- CVS Health (Frankfort, KY)
- …other internal and external constituents in the coordination and administration of the utilization /benefit management function. + Utilizes clinical skills to ... with other products, services and/or programs. + Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization . +… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical Utilization Management ... Administration, or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health… more
- Baylor Scott & White Health (Temple, TX)
- …Is accountable to provide professional leadership and direction in the utilization /cost management (UM) and clinical quality improvement (QI) of the ... + Provide periodic written and verbal reports and updates as required in the Quality Management Program description, the Annual QI Work Plan. + Assure plan… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Supports the Utilization Management clinical teams by assisting with non- clinical administrative tasks and ... responsibilities related to precertification, pre-service, utilization review, care coordination and quality of care. **We are looking for an experienced… more
- University of Colorado (Aurora, CO)
- Clinical Utilization Review Specialist - 32339 University Staff **Description** **University of Colorado Anschutz Medical Campus** **School of Medicine | ... Department of Psychiatry** **Job Title: Clinical Utilization Review Specialist** **Position: #00217340 -...Abilities:** + Well-developed knowledge and skills in areas of utilization management , medical necessity, and patient status… more
- ERP International (Tinker AFB, OK)
- …Duties may include but are not limited to** : Provides Utilization Management activities and functions by using MTF-specific Quality Improvement processes to ... gained from own clinical practice and education relevant to nursing and utilization management . * Participates in the orientation, education and training of… more
- Providence (Seattle, WA)
- …with analysts to provide direction and consultation on utilization management systems and programs and quality initiatives. Identifies opportunities to ... business administration, social science or other related field (preferred) + Certification in utilization management or quality improvement (preferred) + 10… more
- Corewell Health (Southfield, MI)
- …procedures. Additionally, escalates quality and risk issues to the regional Clinical Utilization Management Manager. + Responsible for regularly ... everyone. Together, we are Corewell Health. Scope of work The Clinical Utilization Management (UM) Supervisor is responsible for monitoring, supervising,… more
- Humana (Columbus, OH)
- …Management Strategy Lead will bring deep expertise in utilization management (ie, across in-patient and out-patient clinical services, end-to-end UM ... associates. We seek to (1) ensure members receive safe, high- quality and cost-effective care in a timely manner, (2)...and/or operations experience + Past experience working in a utilization management role (eg, clinical … more
- Virginia Mason Franciscan Health (Bremerton, WA)
- … trends, patterns, and impact to appropriate departmental, Utilization Management , Revenue Cycle, Payer Strategy, and Clinical Joint Operating Committees. ... Franciscan Health, you will find the safest and highest quality of care provided by our expert, compassionate medical...+ Minimum 3 years of clinical case management ( Utilization Management , Denial … more
- CVS Health (Columbus, OH)
- …fully remote and employee can live in any state. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program - Utilizes clinical experience and… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …and collaborating with multidisciplinary teams, influence and direct the delivery and quality of patient care. A hospital-based case management system has ... of administrative/ clinical support staff responsible for assisting with case management for an assigned patient caseload. OTHER + Participates in department… more
- Centene Corporation (Raleigh, NC)
- …to performance, compliance, quality , and efficiency standards + Collaborates with utilization management team to resolve complex care member issues + ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services... utilization management team and senior management to identify opportunities for process and quality… more
- CVS Health (Harrisburg, PA)
- …There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. - Utilizes clinical experience and… more
- CVS Health (Harrisburg, PA)
- …remote and the candidate can live in Pennsylvania. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. - Utilizes clinical experience and… 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 ... Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or CM. Knowledge of Department of Health Care Services… more
- Centene Corporation (Sacramento, CA)
- …team goals and objectives + Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards + Assists ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...Review team to ensure appropriate care to members. Manages utilization management issues related to member care,… more
- UNC Health Care (Raleigh, NC)
- …clinical experience in a medical facility and/or comparable Utilization Management experience. **Knowledge/Skills/and Abilities Requirements:** **Job ... discharge for quality , efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical ...The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure patient… 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 ... technical resource and service, as well as performance and quality . This position supports the ICM model of patient-centric...Degree in a health related field + 3 Years Utilization Management or case management … more