- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of federal,… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- Intermountain Health (Las Vegas, NV)
- …The Manager of Care Management I leads and collaborates with care management operations across utilization review , acute and emergency department care, ... **Preferred Qualifications** + Previous management experience in hospital care management , utilization review , ambulatory care management ,… more
- Humana (Lincoln, NE)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...in an acute care setting + Previous experience in utilization management / utilization review … more
- Waystar (Atlanta, GA)
- …end user adoption of best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as an integral contributor ... **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer Success Organization who will provide clinical… more
- CVS Health (Oklahoma City, OK)
- …health setting required. + Strong knowledge of clinical practice guidelines and utilization management . **Required** **Qualifications** : + Unrestricted OK state ... rotating weekend and holiday schedules. **Preferred** **Qualifications** : + Managed care/ utilization review experience preferred + Experience in a behavioral… more
- Prime Healthcare (Inglewood, CA)
- …provides leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and ... Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... of business. **Knowledge, Skills and Abilities (KSAs)** + Oversight of Utilization Management clinicians while championing process improvement, change adoption… 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...nor does it prohibit the assignment of additional duties. Utilization Management - Laureate Campus Location: Tulsa,… more
- Ochsner Health (New Orleans, LA)
- …experience in discharge planning, case management or utilization review . **Certifications** Required - Current registered nurse license in state of ... implement discharge plans based on patient's individualized needs. Registered Nurse (RN) Case Manager - Case Management ...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more