- Actalent (Santa Barbara, CA)
- …centers - Jack heling hand, alpha resource center, parents helping parents, etc. knowledge of Utilization Management process/ turnaround times. + Familiar ... unit, such as Mental/Behavioral Health services. Skills: Care plans, Case Manager , Pediatrics, Utilization Management , Clinical Reviews Experience… more
- Sharp HealthCare (San Diego, CA)
- …will track and maintain this certification.For Sr Spec ICM assigned to Utilization Management , Train-the-Trainer certification may substitute for ACM or CCM. ... will track and maintain this certification.For Sr Spec ICM assigned to Utilization Management , Train-the-Trainer certification may substitute for ACM or CCM.… more
- Northeast Alabama Regional Medical Center (Anniston, AL)
- …years of clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred. Extensive knowledge and understanding of ... Under the direction of the Case Management Coordinator, coordinates, negotiates, procures and manages the...relate to the working DRG developed by the Case Manager /Coder. Assists with special projects as directed or requested… more
- Hackensack Meridian Health (Edison, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to...the state of New Jersey regulations for Nursing. **Education, Knowledge , Skills and Abilities Required:** + BSN or BSN… more
- Catholic Health Services (Melville, NY)
- …services and coordinates utilization /appeals management review. + Assist Utilization and Appeals Manager in setting up communications with payors and/ ... and Appeals Coordinator will perform activities to help facilitate utilization management and appeals functions to include...and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with… more
- Actalent (Sunrise, FL)
- …and experience. Additional Skills & Qualifications + Valid Florida Driver's License. + Knowledge of case management and utilization review concepts, ... Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests for… more
- Molina Healthcare (Los Angeles, CA)
- …services professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term ... * Assists in implementing health management , care management , utilization management , behavioral health...unrestricted in the state of California. * Certified Case Manager (CCM), Certified Professional in Health Care Management… more
- Texas Health Resources (Arlington, TX)
- Director Utilization Management -Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... leader for system services for wholly owned and Partner hospitals for utilization management . Job Duties OPERATIONS: Plans, organizes and delegates activities… more
- Molina Healthcare (Orlando, FL)
- … (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members have access to all medically necessary prescription… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 250924-5613FP-001 Location East Hartford, CT Date Opened 9/30/2025 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) (Regulatory) position,… more