- LA Care Health Plan (Los Angeles, CA)
- …current and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager ... Requirements Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM),… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Manager , Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support staff. ... Responsibilities + Coordinate day to day operations of the Utilization Management team. + Serve as the primary contact...Experience working within a TPA environment. + Experience with Case Management + Familiarity with call center operations +… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer ... Licensing (must have):** + RN **Desired Licensing (nice to have):** + CCM (Certified Case Manager ) **Required Experience (must have):** + 2 to 3 years … more
- Children's Mercy Kansas City (Kansas City, MO)
- …KS or MO Compact within 60 days of hire + One of the following: American Case Management, Certified Case Manager required upon hire + Employees must obtain ... Case Management or equivalent within 730 days + Employees must obtain Certified Case Manager or equivalent within 730 days + Refer to Nursing and Advanced… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you...administration or related field preferred or commensurate experience and Case Management Certification required + Minimum of 3 years… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Manages the utilization of referral services. Enhances quality of care by assuring compliance with policies, including safety, ... **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages policies… more
- Molina Healthcare (GA)
- …License must be active and unrestricted in state of practice. * Certified Case Manager (CCM), Certified Professional in Health Care Management certification ... in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS),… more
- Elevance Health (Washington, DC)
- …4 days each week. The office is located at 609 H. Street NE.** The ** Manager of Utilization Management** **ll** is responsible for managing a team of physical ... and acuity. + Provides direct oversight and is responsible for Utilization Management execution/decision making for managed member populations. Primary duties may… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …This position uses Microsoft and a web-based application for daily entry of case activity and the utilization management of service authorizations. Educational ... Salary: $65,000/year Position Summary: The UM Program Manager provides oversight and management of service authorization...summ ar ize d ata wit h in the Utilization M an agementSys tem to pr eparere por… more
- Community Health Systems (Franklin, TN)
- …- Registered Nurse - State Licensure and/or Compact State Licensure required + CCM - Certified Case Manager preferred or + Accredited Case Manager (ACM) ... for medical necessity, discharge planning, and payer requirements. + Documents all utilization review activities in the hospital's case management software,… more