- LA Care Health Plan (Los Angeles, CA)
- Supervisor , Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... the safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day… more
- State of Minnesota (Vadnais Heights, MN)
- **Working Title: Utilization Management Supervisor ** **Job Class: State Program Administrator, Director** **Agency: Direct Care and Treatment** + **Job ID** ... our DCT Quality Team for an exciting and rewarding opportunity as a Utilization Management Supervisor ! This position will work across DCT in partnership with… more
- Centene Corporation (Sacramento, CA)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Centene Corporation (Phoenix, AZ)
- …to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... adherence to performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH care member issues related to BH… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team ... internal partners (eg, Provider Relations, Quality) to resolve escalations and address utilization management issues. + Represent UM nursing team in internal… more
- Molina Healthcare (San Francisco, CA)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- AmeriHealth Caritas (Washington, DC)
- …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan is seeking a full-time Professional Care Manager, Supervisor to join our Utilization Management (UM) Clinical Operations team. This position ... for oversight and day-to -day care coordination functions for telephonic, clinical, or utilization management care management staff, including the direct… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print... Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 - $167,136.48 Annually Location Los… more
- Martin's Point Health Care (Portland, ME)
- …Summary The Supervisor is responsible for day-to-day operations of the utilization review team, which includes clinical and non-clinical staff, in the areas of ... years of medical management experience in a managed care setting including utilization review + RN experience in a clinical setting required + Leadership and/or … more