- UPMC (Pittsburgh, PA)
- …The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to ... Are you a registered nurse with a background in utilization management ? UPMC Health Plan is looking...information obtained from interaction with members and providers. + Review and document clinical information from health care providers… more
- UPMC (Pittsburgh, PA)
- …of medical management best practices. + Actively participates in the utilization management and quality improvement review processes, including ... policies of the Health Plan. Contributes to process improvement within the Utilization Management department. + Participates in activities to support policy… more
- Saint Luke's (Lees Summit, MO)
- …plans, directs and implements all services related to case coordination, concurrent review , and utilization management programs, ensuring compliance with ... Capacity Leadership Team for the Health System while owning primary oversight for Case Management at Saint Luke's East Hospital in your new role as Case … more
- Sutter Health (Oakland, CA)
- …Advisor will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to ... case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness… more
- Dignity Health (Bakersfield, CA)
- **Job Summary and Responsibilities** As a Utilization Management RN, you will be crucial in ensuring accurate and compliant medical necessity decisions. Your ... physician review . You'll work closely with both Pre-Service and In-Patient Utilization Management teams to ensure appropriate and cost-effective care. Key… more
- Elevance Health (Indianapolis, IN)
- …center The **Manager Behavioral Health Services** is responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case Management ... cost of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues....and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Primary Responsibilities + Review denied authorization cases within the Utilization Management system to understand the clinical determination and supporting ... About The Role BHPS provides Utilization Review services to its clients....to its clients. The UM Denials Coordinator supports the Utilization Management function by reviewing denied and… more
- ChenMed (Lauderhill, FL)
- …market leaders, external clients and HMO to establish, maintain and support outpatient utilization management in PMR and delegated utilization management ... necessary. **_Other responsibilities may include:_** + Drive the current delegated/non-delegated utilization management model to a sustainable and reproducible… more
- Sevita (Detroit, MI)
- …states to increase census, maintain occupancy, improve daily attendance, and maximize utilization . + Financial Management : + Oversee billing to ensure accuracy ... infants, children, adolescents, Military Service Members and Veterans. **Operations Management Executive Director - State of MI** **Compensation: $140,000-$160,000/year… more
- Evolent (Montgomery, AL)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more