- Option Care Health (Charleston, WV)
- …revenue, margin, and referral growth. Plays an active role in account management and business development efforts with team, engaging customers and both modeling ... opportunities tocoach and provide developmental feedback.Maintain strong relationships with branch management to ensure sales efforts are supported by branch service… more
- Marion County (Salem, OR)
- …& Human Services is looking for an adaptable, collaborative, and experienced Program Manager who will assist the department in achieving its mission: To create a ... to the following Program Development & ManagementProvide program development and management /oversight of a diverse group of programs and teams. Program oversight… more
- CHRISTUS Health (Alamogordo, NM)
- …and reporting individual cases and/or trends to the infection control nurse. Performs utilization management functions as required by payer source. Complies with ... automated InterQual(R) preferred. Knowledge of the regulatory environment, including Medicare Conditions of Participation, DNV standards, HIPAA, and reporting...the Utilization Management Plan. Requirements Education Required: Associate… more
- Mindlance (Gallatin, TN)
- …health plan pharmacy initiatives, such as HEDIS/Star measures and Medication Therapy Management Program (MTMP). . Utilize Pharmacy Benefit Manager resources and ... life. . Perform patient medication therapy monitoring and disease state management counselling. . Document pharmacist interventions within the electronic medical… more
- Marion County (Salem, OR)
- …program. SUPERVISION RECEIVEDWorks under the general supervision of a health program manager or program supervisor who assigns and oversees work, establishes goals ... feedback to staff for professional development. Provides personnel and performance management , including staff recruitment and hiring; new employee orientation; and… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team ... of UM coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and manage various...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- The Cigna Group (Baltimore, MD)
- …at least 5-7+ years of progressive marketing communication and/or strategy experience. Medicare knowledge and management experience is highly preferred. As this ... Leads the development of customer onboarding and marketing plans for the Medicare Advantage customer journey. Communication plans will be multi-modal to include… more
- Humana (Columbus, OH)
- …help us put health first** Humana Healthy Horizons in Virginia is seeking a Manager , Utilization Management (Behavioral Health) who will utilize their ... communication of behavioral health services and/or benefit administration determinations. The Manager , Utilization Management (Behavioral Health) applies a… more
- CareFirst (Baltimore, MD)
- …in the Medicare Advantage Bid process annually, the cost and utilization of all benefits to make adjustments annually, impact of marketing, sales, and ... (strategy, design, execution, and optimization) for products and plans in the Medicare , Medicaid, and Federal Employee Health Benefits categories. Leads the team in… more
- CVS Health (Buffalo Grove, IL)
- …team and external cross-functional teams to build consensus in formulary and utilization management decision-making process and continual enhancement of the ... supporting the creation and maintenance of the CVS Caremark's standard formularies, utilization management programs and other clinical programs assuring clinical… more
- The Cigna Group (Tucson, AZ)
- Pima County based - Medicare Provider Performance Enablement (PPE) Senior Analyst provides broad support to Sr. Supervisor, Sr. Manager , Director, and Other ... interaction with PPE staff as well as other Cigna Medicare departments. Position is exposed to all aspects of...provider demographic records by validating and submitting all data management requests for completion. + Prepare for and participate… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …and collaboratively to facilitate care based on the principles of care management . Facilitation is focused on assessing needs, identifying health care disparities, ... goals to promote optimal member outcomes. + Interpret and apply case management criteria, processes, policies, and regulatory standards to create, follow and… more
- The Cigna Group (Houston, TX)
- …Provider Performance Lead Analyst's responsibilities include: + Supporting the development, management and oversight of the physician/ provider network in his/her ... limited to: preventative and quality outcome metrics, risk adjustment, medical cost management , etc. + Schedules, prepares for and participates in meetings with… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …+ Comprehensive knowledge of utilization management , financial management that includes revenue cycle, Medicare , Medicaid, and commercial admission ... annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the market(s)… 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 ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will...performing UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …safe discharge coverage for all hospital units. + Participates in utilization management initiatives/opportunities for improvement through departmental committee ... accurately and in a timely manner. + Adheres to Medicare and Medicaid regulatory guidelines as it pertains to...Florida. + 3 years minimum experience in discharge planning, utilization management , or case management .… more
- McLaren Health Care (Detroit, MI)
- **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the coordination of patient admission and continued stay ... observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure that… more
- Sharp HealthCare (San Diego, CA)
- …time for routine, urgent and expedited referrals as outlined in SCMG's Utilization Management Plan.Decisions will be communicated to the appropriate persons ... + Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, established criteria such as… more
- Adecco US, Inc. (Dallas, TX)
- We are now in search of a dynamic Utilization Management Nurse for a Direct Hire role with our esteemed client in Dallas, Texas. Experience: + Mandatory five ... hospital setting. + Minimum of two years' experience in Utilization Management within an acute care setting....Proficiency with drafting and submitting reconsiderations and appeals to Medicare for a minimum of one year. + Ideally,… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical and service authorization ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role...clinical areas, including but not limited to surgical procedures, Medicare Part B medications, Long Term Services and Supports… more
