- CVS Health (Phoenix, AZ)
- …plan medical directors. + Attends and participates in clinical meetings with care management and utilization management . Provides subject matter expertise on ... the direction of the Lead Director, Service Operations, this position will focus on utilization , quality and fraud waste and abuse review for individual cases… more
- New York State Civil Service (Orangeburg, NY)
- …departments assigned to the Quality Management Program - program evaluation, risk management , utilization review , health information management , and ... program evaluation, clinical risk management , standards compliance, survey readiness, utilization review , or a closely related area; or 2. Three (3) years of… more
- New York State Civil Service (Albany, NY)
- …mental illness in a clinical capacity, as well as experience with utilization management and/or utilization review . ? The ideal candidate(s) will have ... direct care and utilization management experience, including familiarity with the review of medical evidence, psychiatric evidence, a knowledge base of… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role BHPS provides Utilization Management (UM) services to its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal ... accurate decisions + Ensure strict adherence to Appeals and Utilization Management (UM) processes and regulatory and...URAC, NCQA, and ERISA + Proficiency in Clinical Appeals, Utilization Review , and Grievance processes including benefit… more
- Molina Healthcare (Reno, NV)
- …Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** * Utilization management experience. * Health plan/managed care ... of stay for requested treatments and/or procedures. * Works collaboratively with the utilization and care management departments to provide ABA and behavioral… more
- Ross Stores, Inc. (Dublin, CA)
- …contracts, identifies embedded leases and applies proper accounting treatment for management utilization in decision making process\. * Drive cross\-functional ... 404\) controls including but not limited to account reconciliations and trial balance review , and Identity and Access management compliance for users of… more
- LA Care Health Plan (Los Angeles, CA)
- …Technician II (1 yr contract. weekends must)) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... achieve that purpose. Job Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and… more
- UnityPoint Health (Des Moines, IA)
- …to plan and execute a safe discharge + Collaborate with Utilization Management team on continued stay review . + Collaborates with patients, caregivers, ... continuity through elimination of fragmentation of care/service and facilitates the effective utilization of resources. Serves as educator and a central source of… more
- Ascension Health (Jacksonville, FL)
- …of recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a ... of care and length of stay determination. + Assist and manage the denial management process. + Review and offer suggestions related to resources and service… more
- Ascension Health (Hoffman Estates, IL)
- …work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. This position reports directly to the ... of care and length of stay determination. + Assist and manage the denial management process. + Review and offer suggestions related to resources and service… more