- Evolent (Pittsburgh, PA)
- …medical review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation. **Core ... Responsibilities** + **Team Leadership & Performance Management ** + Lead and manage a team of medical oncologists responsible for reviewing oncology cases. +… more
- Elevance Health (Hendersonville, TN)
- …related field, including prior management experience and clinical, quality, and/or utilization management experience in a managed care setting; or any ... Directs and oversees program operations in support of corporate and health plan management in execution of clinical service delivery. + Monitors national and local… more
- Diversicare Healthcare Services & Diversicare Ther (Hartford, AL)
- …Degree in nursing 2. RN License 3. Knowledge of healthcare reimbursement, utilization management , and discharge planning. 4. Experience providing strategic ... in and facilitate Engage/72 HR Admission meetings as part of the care management system. + Manage the restorative nursing program, integrating it with the activity… more
- Wiser (St. Louis, MO)
- …ArcGIS Pro software tools in the creation, attribution, schema development and utilization , management , and geo-referencing of data. + Experience in geo-enabling ... shall use an understanding of geography, research, GIS, and data conflation and management skills to produce the broad array of human geography products including… more
- UCLA Health (Los Angeles, CA)
- …care experience or knowledge of maternal child health agencies. + Case management / utilization management , health education and/or discharge planning ... CL will offer some administrative support and will maintain case management activities for non-positive NBS results and data verifications. Primary responsibilities… more
- Prime Healthcare (Chula Vista, CA)
- …EDUCATION, EXPERIENCE, TRAINING Required qualifications 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and ... development and implementations of discharge plans. Assists with case management referrals and authorizations. Maintains and coordinates Medicaid state submission… more
- Scripps Health (San Diego, CA)
- …overall administration, operation, direction, design, financial performance, human resource management , regulatory compliance, quality, utilization management ... in La Jolla. This is an exempt and salaried position eligible for the Management Incentive Compensation Plan (MICP) at the Director level.* *Why Scripps Memorial La… more
- Humana (Honolulu, HI)
- …and interpretation skills with prior experience leading teams focusing on quality management , utilization management , discharge planning and/or home health ... on continuously improving consumer experiences **Preferred Qualifications** + Medical management experience, working with health insurance organizations, hospitals and… more
- Trinity Health (Philadelphia, PA)
- …nursing required. + Active PA RN License required. + Three (3) years of utilization management or case management experience, including emphasis on discharge ... planning. + Case Management certification from an accredited organization preferred **We offer a competitive salary and comprehensive benefits including:** +… more
- Molina Healthcare (Louisville, KY)
- …with multidisciplinary teams to promote Molina care model. * Adheres to utilization management (UM) policies and procedures. * May work collaboratively ... with behavioral health medical directors, and senior medical directors to ensure proper management of the BHT benefit. Required Qualifications * At least 2 years… more
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