- Commonwealth Care Alliance (Boston, MA)
- …and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM)… 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
- Catholic Health Services (Melville, NY)
- …ensure timely follow through. + Reviews providers' requests for services and coordinates utilization /appeals management review . + Assist Utilization and ... Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and appeals functions to include coordination of… more
- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... support to the hospital and treatment team throughout the review of patients, their placement in various levels of...and benefits of patients, matching the level of care utilization . Assures compliance with Managed Care Behavioral Health standards… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Mount Sinai Health System (New York, NY)
- …Excel and Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...EOW** To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring… more
- Northeast Alabama Regional Medical Center (Anniston, AL)
- …years of clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred. Extensive knowledge and understanding of ... Under the direction of the Case Management Coordinator, coordinates, negotiates, procures and manages the...with special projects as directed or requested by the supervisor or department director. Performs Concurrent Review … more
- State of Massachusetts (Brockton, MA)
- …of Mental Health* **Title:** *DMH Child Youth and Family Case Management Supervisor - Human Services Coordinator II* **Location:** *Massachusetts-Brockton-165 ... Supervisor has the responsibility of monitoring performance and utilization of assigned Area or Site-based CYF contracts and...and liaison to the Community Service Agencies. The CYF Supervisor will oversee case management and administrative… more
- Mohawk Valley Health System (Utica, NY)
- …population. Provides direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member ... RN Supervisor Case Management - Full Time...SNH is responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member… more
- NANA Regional Corporation (Colorado Springs, CO)
- AFO is looking for an Installation Property Book (IPBO) / Supply Subsistence Management (SSMO) Supervisor to work in Colorado Springs, CO. To join our team of ... develops resolution of all related tasks, issues and/or problems with property management . The CIPBO Supervisor plans work independently and develops analytical… more