- Hackensack Meridian Health (Brick, NJ)
- …a leader of positive change. The role of ** Supervisor , Care Management ** integrates and coordinates utilization management , care coordination, discharge ... acute care setting. + Familiar with hospital resources, community resources, and/or resource/ utilization management . + Care coordination, case management or… more
- Molina Healthcare (NM)
- …team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management activities ... at the right time. + Functions as a hands-on supervisor , coordinating and monitoring clinical and non-clinical team activities...Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and… 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 the ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 - $167,136.48… more
- Centene Corporation (Columbus, OH)
- …IN STATE OF OHIO IDEAL CANDIDATE WILL HAVE PRIOR AUTHORIZAION OR UTILIZATION MANAGEMENT EXPERIENCE PEOPLE LEADER EXPERIENCE STRONGLY PREFERRED **Position ... Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical ...ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks… 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
- BayCare Health System (Tampa, FL)
- …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years...Review or + Required 2 years in Case Management or + Required 3 years Registered Nurse +… more
- BayCare Health System (Clearwater, FL)
- …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years...Review or + Required 2 years in Case Management or + Required 3 years Registered Nurse +… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role in ensuring CCA meets ... Utilization Management Reviewer reports to the Utilization Management Manager. * Conducts timely clinical decision review for services requiring… 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
- 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