- Rady Children's Hospital San Diego (San Diego, CA)
- …Manager, the UM Operations Trainer's primary job function is to support Utilization Management operations by training non-clinical staff on how to successfully ... perform any non-clinical tasks. This includes, but is not limited to, initial authorization processing (data entry, eligibility verification, benefits verification, and requesting required supporting documents from submitting provider offices), answering the… more
- Integra Partners (Troy, MI)
- …experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key ... role in collaborating with our Medical Director to perform benefit and medical necessity reviews and appeals within an NCQA-compliant UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse's responsibilities include… more
- Prime Healthcare (Redding, CA)
- …(https://careers-primehealthcare.icims.com/jobs/222168/social-worker-ii utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... FacilityShasta Regional Medical Center LocationUS-CA-Redding ID2025-222168 CategoryClinical Professional Position TypeFull Time ShiftDays Job TypeNon-Exempt more
- Northeast Alabama Regional Medical Center (Anniston, AL)
- …of clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred. Extensive knowledge and understanding of medical ... terminology and medical science, for effective review of medical records and processes of care. more
- WestCare Foundation (Henderson, NV)
- …or RN and/or Bachelors or Masters level CADC/LADC with 2 years utilization review experience, preferred experience working with individuals with psychiatric or ... substance use disorder Experience and Competencies: + Proven experience in conceptualizing a case and creating a clinical impression to present to all involved and approved parties, including managed care representatives + Knowledge of CPT, ICD 9 & ICD 10… more
- University of Rochester (Rochester, NY)
- …as defined by NYS Laws and Regulations. The Pharmacy Medication Utilization and Inventory Compliance Manager has direct supervision and management responsibilities ... for the pharmacy stockroom, controlled substance vault and other medication inventory management locations, and is intended to be a 'line manager' level of responsibility, covering shifts typical of their team while utilizing protected time to advance the… more
- Prime Healthcare (Redding, CA)
- …(https://careers-primehealthcare.icims.com/jobs/232661/social-worker-ii utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... FacilityShasta Regional Medical Center LocationUS-CA-Redding ID2025-232661 CategoryClinical Professional Position TypePart Time < 60 ShiftDays Job TypeNon-Exempt more
- Ascension Health (Baltimore, MD)
- …of hire. **Additional Preferences** + One year of **recent** experience in Utilization Management required. + Local and national travel options are available ... depending on need. Candidates are stipend eligible for sites over 50+ miles from their permanent residence. Partner with Recruitment to learn more \#ATP **Why Join Our Team** Ascension associates are key to our commitment of transforming healthcare and… more
- Sharp HealthCare (San Diego, CA)
- …Every Other **On-Call Required:** No **Hourly Pay Range (Minimum - Midpoint - Maximum):** $34.170 - $44.090 - $49.370 The stated pay scale reflects the range that ... **Facility:** Copley Drive **City** San Diego **Department** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Other; California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians… more
- Veterans Affairs, Veterans Health Administration (Arlington, TX)
- …THIS IS A DETAIL OPPORTUNITY - NOT TO EXCEED 120 DAYS You will render expert contract pre-award and post award expertise to all administrative and clinical services ... within the medical center and supported catchment area. Duties include, but may not be limited to the following: Develops procedures, policies, and supporting artifacts to ensure procurement activities are consistent with Federal Acquisition Regulations (FAR),… more