- Sanford Health (Sioux Falls, SD)
- …**Department Details** The Intake Coordinator position supports the Health Plan Utilization Management team and assists with members and provider calls related ... of members. For individuals supporting clinical areas, additional duties are: Utilization management performs resource benefit policy management, triages inbound and… more
- Elevance Health (West Des Moines, IA)
- ** Utilization Management Representative II** **Location:** The selected candidate for this position must reside in Iowa. **_Virtual:_** This role enables associates ... unless an accommodation is granted as required by law._ The ** Utilization Management Representative II** is responsible for managing incoming calls, including… more
- CenterWell (San Juan, PR)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare +… more
- UNC Health Care (Kinston, NC)
- …the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established criteria to ... of applied clinical experience as a Registered Nurse required. + 2 years utilization review, care management, or compliance experience preferred. + Minimum 1 year… more
- AmeriHealth Caritas (LA)
- …Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity ... InterQual and American Society of Addiction Medicine (ASAM) criterion + Utilization management experience within a managed care organization desired + Proficiency… more
- CenterWell (Austin, TX)
- …Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid… more
- Westborough Behavioral Healthcare Hospital (Westborough, MA)
- …hospital operates 24/7 with multiple shifts available. Job Description: The Utilization Review Specialist is responsible for monitoring adherence to the hospital's ... utilization review plan to ensure the effective and efficient use of hospital services. Monitors the appropriateness of hospital admissions and extended hospitals… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and Blue Shield of Minnesota Position Title: Senior Business Analyst - Utilization Management Location: Hybrid | Eagan, Minnesota Career Area: Information Technology ... business solutions through research, audit, and analysis of data for Utilization Management. Your Responsibilities * Participates in process change and redesign… more
- Sharp HealthCare (San Diego, CA)
- …track and maintain this certification.For Sr Spec ICM assigned to Utilization Management, Train-the-Trainer certification may substitute for ACM or CCM. **Essential ... track and maintain this certification.For Sr Spec ICM assigned to Utilization Management, Train-the-Trainer certification may substitute for ACM or CCM. **Knowledge,… more
- Medical Center Hospital (Odessa, TX)
- + Position Summary: The Utilization Review Specialist/Outcomes Specialist conducts concurrent and retrospective review functions in support of the hospital ... Utilization Review Program and makes appropriate referrals to designated Physician Advisors. + Qualifications: A. Education: Holds a current Texas license as a… more