- Sharp HealthCare (San Diego, CA)
- …by our recruitment and hiring teams. **What You Will Do** To provide comprehensive utilization management and coordination of care for SRS Members. Ensure timely ... experience as an LVN in a hospital or clinical setting. + 2 Years utilization /Case Management experience, preferably in a Managed Care setting. + Experience as… more
- Houston Behavioral Healthcare Hospital (Houston, TX)
- …for Part-time Utilization Management Coordinator. The Utilization Management Coordinator will report to the Director of Utilization Review ... Houston Behavioral Healthcare Hospital (HBHH) is unique in so many...and will be responsible to provide quality case management services to all patients and their families, to… more
- CommonSpirit Health (Phoenix, AZ)
- **Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is charged with ... to promote a coordinated approach to utilization management . Communicate effectively with physicians, healthcare providers,...required. + Minimum 7 years of experience in a director level, or equivalent leadership role, required. + Prior… more
- Humana (Lansing, MI)
- …part of our caring community and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and independent ... best and most appropriate treatment, care, or services for Enrollees. The Utilization Management Nurse Lead coordinates and communicates with Providers,… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- …an interdisciplinary approach to support continuity of care. + Provides utilization management , transfer coordnation, discharge planning, and issuance of ... The UR Specialist reviews and monitors patients' utilization of health care services with the goal...and quality of care. + Responsible for the proactive management of patients with the objective of improving quality… more
- ERP International (Barksdale AFB, LA)
- …co-workers, families, peers, and other health team members. Submits all concerns through Utilization Management Director ; be able to identify, analyze and ... **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for...and criteria to review thequality, completeness, and adequacy of healthcare provided within the MTF, as well asits necessity,… more
- LA Care Health Plan (Los Angeles, CA)
- …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II...data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… more
- AdventHealth (Altamonte Springs, FL)
- …**Job Location** : Remote **The role you will contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a...for specific performance and/or outcome indicators as determined by Director of Care Management . * Documents key… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …Minimum 5-10 years of progressively responsible experience in medical management , or utilization review within a healthcare plan, ACO, or provider system. + ... responsible for the strategic direction, leadership, and oversight of all medical management functions, including Utilization Management , and Quality… more