- Molina Healthcare (NM)
- …Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... at the right time. + Functions as a hands-on supervisor , coordinating and monitoring clinical and non-clinical team activities...Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management … more
- Centene Corporation (Columbus, OH)
- …REMOTE BUT CANDIDATE MUST RESIDE IN STATE OF OHIO IDEAL CANDIDATE WILL HAVE PRIOR AUTHORIZAION OR UTILIZATION MANAGEMENT EXPERIENCE PEOPLE LEADER EXPERIENCE ... key initiatives and to facilitate on-going communication between utilization management team, members, and providers + Monitors prior authorization,… 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
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical ... and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role in ensuring CCA meets CMS… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse!Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ... Working under the general supervision of the Director and/or Manager/ Supervisor of Medical Management , and in collaboration...activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management … more
- Veterans Affairs, Veterans Health Administration (Augusta, GA)
- Summary The Nurse Utilization Management (UM) Registered Nurse (RN) is responsible for providing competent, evidence-based practices within the position. The UM ... prospective, observation, admission, and continued stay patients. Responsibilities The Nurse Utilization Management (UM) Registered Nurse (RN) is responsible and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- University of Utah Health (Salt Lake City, UT)
- … to reassign staff based on census and workload, adhering to the Nurse Utilization Policy. + Assist Hospital Supervisor and Nursing Leadership in identifying ... and trust that are integral to our mission. EO/AA_ The Staff Utilization Coordinator is responsible for providing healthcare operational support services, including… more
- State of Massachusetts (Boston, MA)
- …staff and hospital-wide teams. * Ensure timely and accurate dissemination of utilization management data across departments and maintain compliance with evolving ... **Medical Services* **Organization:** **Department of Public Health* **Title:** *Case Management Supervisor * **Location:** *Massachusetts-Boston-170 Morton Street* **Requisition… more
- Mohawk Valley Health System (Utica, NY)
- RN Supervisor Case Management - Full Time - Days Department: CARE MANAGEMENT SERVICES Job Summary The Supervisor Case Management - SNH is responsible ... for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include the supervision and… more