- Magellan Health Services (San Diego, CA)
- …relationships at all levels within HAI-CA. Interact with HAI-CA CMC Chief Clinical Officer, Medical Director and Associate Medical Director , Physician ... customer's site. Including, but not limited to, Network, QI, UM , and DVOD meetings. + Track agenda and follow... data; under the direction of the supervisor or Medical Director , assists with discharge planning and… more
- Providence (Everett, WA)
- …and evaluation of appropriate services and resources to maximize optimum outcomes. The UM Supervisor assists the Washington NWR Director of Care Management in ... **Description** The Supervisor for Utilization Management provides a key role in leading,...- they're invaluable. Join our team at Providence Regional Medical Center Everett and thrive in our culture of… more
- Covenant Health (Nashua, NH)
- …days by utilization of avoidable day tracking in the electronic medical record. + Develops and maintains professional relationships with department team members ... the Hospitalist group and UR nurses to determine level of status based on medical necessity + Responsible for collaborating with physicians, the UR staff to identify… more
- Centene Corporation (Austin, TX)
- …practice models and utilization management processes + Interact with the Medical Director , or designee, to discuss clinical authorization questions and ... 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national...the Central Time Zone + TX licensure required + Utilization Management ( UM ) experience strongly preferred Pay… more
- MTC (Anson, TX)
- …to the health services administrator, and clinically to the MTC Corporate Medical Director . Responsible for providing medical services related ... Full time, Monday - Friday, day schedule** **Benefit package includes:** + ** Medical , Vision, Dental, and Prescription Drug Benefits** + **Life, Accidental Death and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity ... consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …duty and reserve/guard referrals under the supplemental health care program. Coordinate with Medical Director , Product Line leaders, and/or RM leadership for all ... have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management ( UM ) experience is preferred. Full-time employment in a… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …all mandatory trainings as required.* May be required to attend Fair Hearings with Medical Director relating to specific cases.* Works independently, as well as ... Community Health Assessment (CHA) Tools to determine functional status, medical , behavioral, psychological, and community resource needs for coordinating,… more
- Highmark Health (Wexford, PA)
- …) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required. (20%) + Within the context of the request, ... + Responsible for all preauthorization entries into applicable databases (ie internal medical claims systems, PBM pharmacy systems) to ensure swift and appropriate… more
- University of Michigan (Ann Arbor, MI)
- …care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School ... $46.27-$69.89 / hour** The benefit package includes: + Excellent medical , dental and vision coverage + 2:1 Match on...and the organization/system. The CNS and the Clinical Nursing Director are partners in leading the nursing clinical practice… more