- CVS Health (Columbus, OH)
- …shift times are not permitted. **Required Qualifications** + 3+ years Utilization Management or Utilization Review experience. + 3+ years clinical ... high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our...the state that they reside, with strong experience in utilization review , coding, and managed care. **Key… more
- Commonwealth Care Alliance (Boston, MA)
- …and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- UPMC (Pittsburgh, PA)
- …Life Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, ... The Medical Director, Utilization Management is responsible for assuring...and potential quality of care concerns. + Provide expedited review and determination of medically pressing issues in accordance… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Access Dubuque (Dubuque, IA)
- … Utilization Management Assistant answers first level calls in Utilization Review for member participants. They will evaluate certification requests by ... Utilization Management CNA **Cottingham & Butler/... Utilization Management CNA **Cottingham & Butler/ SISCO** 1 Positions...will also triage the call to determine if a Utilization Review Nurse is needed to complete… more
- Humana (Lansing, MI)
- …Nurse (RN) license in the state of Michigan. + Previous experience in utilization management and/or utilization review . + Minimum of two (2) years of ... of our caring community and help us put health first** The Manager, Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership experience.… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for members who may ... use of the member's benefit to provide the best quality care. The TeamThe Clinical Utilization Reviewer is part of a highly dedicated and motivated team of… more
- Molina Healthcare (GA)
- …or more of the following activities: care review , care management , utilization management (prior authorizations, inpatient/outpatient medical necessity, ... professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term services and… more
- CVS Health (Baton Rouge, LA)
- …members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the ... team maintains compliance and privacy practices. + Oversees the implementation of utilization management services for assigned area + Implements clinical… more