- South Middlesex Opportunity Council (Framingham, MA)
- …casual Working Conditions: As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact with ... children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. Candidates must… more
- Community Health Systems (Franklin, TN)
- …preferred **Knowledge, Skills and Abilities** + Strong knowledge of utilization management principles, payer requirements, and healthcare regulations. ... Summary** The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals… more
- Saint Francis Health System (Tulsa, OK)
- …in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal ... the Process Improvement/Quality Director, to appropriate clinicians and to the UM Manager . Reviews eligibility and benefits of patients, matching the level of care… more
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** +… more
- Elevance Health (Costa Mesa, CA)
- …I** The Behavioral Health Care Manager I is responsible for conducting utilization management reviews for mental health and substance use disorder inpatient ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: Reports to the Manager of Pharmacy Benefits and other delegated pharmacist. Facilitates the operations of the Pharmacy Care Management ... Department by organizing, improving, and implementing pharmacy benefit management policies and procedures. Major areas of responsibility include oversight of the… more
- US Tech Solutions (Columbia, SC)
- …established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to ... Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of Care Referrals, etc.). Participates… more
- Providence (Irvine, CA)
- …strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The ... Utilization Management RN must effectively and efficiently manage a diverse...UR environment or working as an acute hospital case manager . **Preferred Qualifications:** + Bachelor's Degree Nursing. + Master's… more
- Providence (Mission Hills, CA)
- …strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The ... Utilization Management RN must effectively and efficiently manage a diverse...UR environment or working as an acute hospital case manager . **Preferred Qualifications:** + Bachelor's Degree in Nursing. +… more
- Trinity Health (Mishawaka, IN)
- …and detail-oriented **RN** **Case Manager ** to coordinate patient care, utilization management , and discharge planning. This role ensures quality outcomes, ... of clinical nursing experience; critical care experience preferred + Case management certification preferred + Strong communication, critical thinking, and computer… more