- LA Care Health Plan (Los Angeles, CA)
- Supervisor , Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM)...in Nursing Experience Required: Minimum of 7 years of acute/ clinical care experience. Minimum of 2 years of experience… more
- AmeriHealth Caritas (Washington, DC)
- …ON BONUS** **Role Overview:** Under the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- UPMC (Pittsburgh, PA)
- …is seeking a full-time Professional Care Manager, Supervisor to join our Utilization Management (UM) Clinical Operations team. This position follows a ... is responsible for oversight and day-to -day care coordination functions for telephonic, clinical , or utilization management care management staff,… more
- Molina Healthcare (Sacramento, CA)
- … and non- clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting standards. ... + 3+ years clinical nursing experience. + 2+ years utilization management experience. + Experience demonstrating leadership skills. **Required License,… 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
- 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
- Martin's Point Health Care (Portland, ME)
- …Position Summary The Supervisor is responsible for day-to-day operations of the utilization review team, which includes clinical and non- clinical staff, ... 3 years of medical management experience in a managed care setting including utilization review + RN experience in a clinical setting required + Leadership… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to ... staff, members and providers. + Provides backup for the Supervisor , whenever necessary. Participates in the orientation of new...Bachelors degree preferred. + Minimum of three years of clinical experience required. Utilization Management … more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- Ventura County (Ventura, CA)
- …as needed for outside services for patients/families; + Conducts daily clinical reviews for utilization /quality management activities based ... Senior Registered Nurse - Hospital Management Utilization Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5061650) Apply ...+ Preceptor Pay - $2.50 per hour + House Supervisor Pay - $4.00 per hour + Charge Nurse… more