- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …inpatient, and extended recovery admissions as required based on Emory Healthcare's Utilization Management Plan and the UR Department processes. 4. Ensures ... of Georgia and Federal regulatory requirements as designated in Emory Healthcare's Utilization Management Plan. 3. Maintains all required annual competencies,… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Team Lead plays a key role in supporting the day-to-day operations of the UM team and serves as a liaison between frontline ... limited to: + Support the day-to-day operations of the Utilization Management team + Provide leadership, guidance,...clinical appeals and refer as needed to the Medical Director + Communicate effectively and professionally with team members,… more
- Seattle Children's (Seattle, WA)
- …experience caring for children with medical complexity Current or previous hospital case management or utilization review experience Current or previous case ... In partnership with the director , Care Coordination provides leadership, supervision, and oversight...management or utilization review leadership experience **Compensation Range** $115,277.00 - $172,915.00… more
- Houston Behavioral Healthcare Hospital (Houston, TX)
- …Utilization Management Coordinator, Monday-Friday, 8a-4p. The Lead Utilization Management Coordinator will report to the Director of Utilization ... Review and will be responsible to provide quality case management services to all patients and their families, to serve as a member of interdisciplinary team… more
- CVS Health (Tallahassee, FL)
- …every day. **Position Summary** **Fully remote with requirement to reside in Florida.** + Utilization Management is a 24/7 operation and the work schedule may ... specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. **Required Qualifications** + Must have...in Florida + 3+ years of clinical experience + Utilization Management is a 24/7 operation and… more
- University of Utah Health (Salt Lake City, UT)
- …and trust that are integral to our mission. EO/AA_ The Staff Utilization Coordinator is responsible for providing healthcare operational support services, including ... Timekeeping team. Collaborating closely with Nursing Leadership, the Staff Utilization Coordinator reviews and develops schedules based on agreed-upon staffing… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of our hospital. Overview To provide leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal ... of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient… more
- Covenant Health (Nashua, NH)
- Summary Conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed on a nursing unit, to include ... and quality of care and communicates findings to the director of the department. + Maintains current knowledge of...of five years broad clinical experience preferred + Case management and/or Utilization Management experience… more
- Guthrie (Troy, PA)
- Up to a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other ... Packer Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior… more