- Campbell County Health (Gillette, WY)
- …focuses on integrating care management , social services, discharge planning, utilization review and post-hospital services to ensure clinical efficacy and ... functions of care coordination, facilitation of referrals, education, discharge planning, utilization management , and advocacy. ESSENTIAL FUNCTIONS * Completes… more
- Martin's Point Health Care (Portland, ME)
- …Summary The Supervisor is responsible for day-to-day operations of the utilization review clinical team, in the areas of authorization requests, ... + 3+ years of medical management experience in a managed care setting including utilization review + RN experience in a clinical setting + Leadership and/or … more
- Centene Corporation (Madison, WI)
- … 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
- CareFirst (Baltimore, MD)
- …programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Utilization Management **Equal Employment ... **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination… more
- Molina Healthcare (North Las Vegas, NV)
- …services professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term ... Essential Job Duties * Assists in implementing health management , care management , utilization management , behavioral health and other program activities… more
- Point32Health (Canton, MA)
- …. **Job Summary** Under the direction of the Pharmacy Utilization Management (UM) Supervisor , the Clinical Pharmacist is responsible for ... authorization (PA) requests for coverage determinations (CD), and exceptions. The Clinical Pharmacist ensures timely disposition of reviews for CD and exceptions… more
- Covenant Health Inc. (Knoxville, TN)
- …audits thus promoting a culture of professional expertise in utilization management . + Provides monitoring and oversight of non- clinical utilization ... Overview Registered Nurse Utilization Management Full Time, 80 Hours...and written communication skills in order to clearly present clinical and financial data to various audiences as necessary.… more
- Saint Francis Health System (Tulsa, OK)
- …notification and performing Nonclinical roles .** Job Summary: Provides administrative and clinical support to the hospital and treatment team throughout the review ... in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal… more
- Catholic Health (Buffalo, NY)
- …Clinical Documentation Integrity. The Middle Revenue Cycle - Clinical Supervisor is responsible for training and mentoring Utilization Review, Clinical ... coverage as needed Summary: The Middle Revenue Cycle - Clinical Supervisor , as an active member of...one of the major consultant firms + Proficiency in utilization management / clinical documentation Integrity and… more
- Helio Health Inc. (Syracuse, NY)
- …Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management ... track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our Inpatient,… more
