- Martin's Point Health Care (Portland, ME)
- …or delegates projects. + Works closely with the Manager Care Management, Director Health Management, Utilization Review managers/ supervisors, Quality ... Department staff, medical director staff, and Compliance and legal counsel on a variety of departmental functions and issues, as necessary. + Works as a Care Manager in a back-up capacity as needed based on workload needs. Education/Experience: +… more
- Actalent (Sunrise, FL)
- …UMN assists in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ... + Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management +… more
- LA Care Health Plan (Los Angeles, CA)
- …Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires extended review . Collaborates with ... Utilization Management Admissions Liaison RN II Job Category:...specific to the case type. Identifies requests needing medical director review or input and presents for… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director /Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition ... improvement programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. + Performs… 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 make ... **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale AFB,… 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
- Access Dubuque (Dubuque, IA)
- …you! The Utilization Management Assistant answers first level calls in Utilization Review for member participants. They will evaluate certification requests ... the group specific requirements and will also triage the call to determine if a Utilization Review Nurse is needed to complete the call. You will be responsible… more
- McLaren Health Care (Indianapolis, IN)
- …for utilization management functions. This includes but is not limited to review and authorization of services, utilization of medical policy, utilization ... We are looking for a Utilization Management RN, to join us in leading...and under and overuse of services. Collaborates with Medical Director and senior management on complex cases and special… more
- BrightSpring Health Services (Dunbar, WV)
- …days of death and submit to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at least monthly to ensure ... are coordinated with behavioral and programmatic staff in partnership with the Executive Director . The Director of Nursing is accountable for overseeing the… more
- Ventura County (Ventura, CA)
- …+ Experience with managed care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs + At ... of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff...care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review … more