- Wellpath (Lemoyne, PA)
- …**How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review , case management , quality ... care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners… more
- Healthfirst (NY)
- …maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** + ... closely with other Operations leaders including but not limited to Care Management , Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review , care management and quality to determine the ... network physicians for peer-to-peer case discussion. + Provides clinical support for utilization review , care management and quality to determine the medical… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …the appropriate utilization of resources, coordination of payer communication, and utilization review and management . Responsible for carrying out duties ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional...functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to… more
- Huron Consulting Group (Chicago, IL)
- … Utilization Review Plan and the overall operation of the Utilization Management Department in accordance with federal, state and local guidelines, ... hospital contractual payor agreements. This position reports to the Director of Utilization Management and...+ Staff Acquisition and Support: Leads and manages the utilization review staff and function for the… 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 ... and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work...and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating… more
- Community Health Systems (Franklin, TN)
- …discharge planning, and payer requirements. + Documents all utilization review activities in the hospital's case management software, including clinical ... Nursing preferred + 2-4 years of clinical experience in utilization review , case management , or...part of the application or hiring process, contact the director of Human Resources at the facility to which… more
- Community Health Systems (Naples, FL)
- Join us as a **Registered Nurse (RN) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is an ... 401k match & more available for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews hospital admissions, extended stays, and… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC - Clear Lake Center - Compressed weekend night shift Friday - Sunday **Webster, Texas, United States** **New** Nursing & Care ... efficient use of medically appropriate services. Integrates and coordinates utilization management activities, care coordination, discharge planning functions,… more
- CVS Health (Columbus, OH)
- …including phone, computer, etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management experience. ... the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital… more