- Elevance Health (Walnut Creek, CA)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... 8:35 AM to 5:05 PM Pacific. Training hours may vary. The ** Utilization Management Representative I** is responsible for coordinating cases for precertification and… more
- South Middlesex Opportunity Council (Framingham, MA)
- …individuals, children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. ... and in a timely fashion, for the RRS and outpatient clinic programs. + Review denials and partially paid claims and resolve discrepancies. + Assist in resolving… more
- Elevance Health (West Des Moines, IA)
- ** Utilization Management Representative II** **Location:** The selected candidate for this position must reside in Iowa. **_Virtual:_** This role enables associates ... unless an accommodation is granted as required by law._ The ** Utilization Management Representative II** is responsible for managing incoming calls, including… more
- Healthfirst (NY)
- …maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** + ... Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions** + **Partner with technology and data teams to refine data… more
- CenterWell (San Juan, PR)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CenterWell (Austin, TX)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- Ellis Medicine (Schenectady, NY)
- …provided by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and social ... SECTION I BASIC FUNCTION: The RN Case Manager has responsibility for case management of assigned...in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly… more
- UNC Health Care (Goldsboro, NC)
- …authorizations. 6. Escalate matters/scheduled accounts that require attention to Pre-Arrival Team Lead/ Manager . 7. Notify Utilization Review & Case ... Management regarding any admissions that need Clinical Review . 8. Review /Sign/Commit to the Patient Access Work Standards approved by Human Resources 9. … more
- Mohawk Valley Health System (Utica, NY)
- …care to our diverse member population. Provides direct oversight of the case manager 's daily operations of utilization review practice, process and ... responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include the supervision… more
- Mohawk Valley Health System (Utica, NY)
- …care to our diverse member population. Provides direct oversight of the case manager 's daily operations of utilization review practice, processes and ... responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include the supervision… more