- Elevance Health (Indianapolis, IN)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... ** Utilization Management Medical Director - Indiana Medicaid** **Location:**...services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and… more
- CenterWell (San Juan, PR)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional… more
- CenterWell (Austin, TX)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience +… more
- Healthfirst (NY)
- … Plan (MLTCP).** + **Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care operations** + **Work experience ... discipline and capacity for executive-level decision-making** + **Experience working as a case manager for a long-term care programs such as PACE, MAP or… more
- South Middlesex Opportunity Council (Framingham, MA)
- …individuals, children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. ... indemnity, and Short-Term Disability. + Flexible Spending Accounts, Dependent Care Accounts, Employee Assistance Program, Tuition Reimbursement and more. Primary… more
- Elevance Health (West Des Moines, IA)
- ** Utilization Management Representative II** **Location:** The selected candidate for this position must reside in Iowa. **_Virtual:_** This role enables associates ... unless an accommodation is granted as required by law._ The ** Utilization Management Representative II** is responsible for managing incoming calls, including… more
- Stanford Health Care (Palo Alto, CA)
- …complex needs in collaboration with other interdisciplinary team members; arranges follow up care as appropriate. + Utilization Review -- Reviews ... include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review ...Manager differs from other roles in professional nursing/health care practice in that it is not intended to… more
- UNC Health Care (Chapel Hill, NC)
- …satisfaction by promoting high-quality, coordinated care . **What You'll Do** As a Care Manager RN, you'll: + Provide ongoing support and clinical expertise ... + Serve as a key resource in case management, utilization review , and discharge planning. + Stay...well-being of the unique communities we serve. Summary: The Care Manager RN plays a crucial role… more
- ChenMed (Newport News, VA)
- …engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family ... your kindness and joy? We're different than most primary care providers. We're rapidly expanding and we need great...achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... provide requested clinical and psychosocial information to assurereimbursement. + Utilization Review -- Reviews prospectively, concurrently and retrospectively… more