- 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
- CVS Health (Austin, TX)
- …management team and utilization management team. The Care Management Associate will review eligibility and benefits and open pre-certification cases ... all with heart, each and every day. **Position Summary** The Care Management Associate (CMA) supports comprehensive coordination of medical services that include… 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
- 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
- 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
- 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
- Evolent (Sacramento, CA)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- CVS Health (Richmond, VA)
- …involving members across Aetna. **Expectations and Responsibilities:** * Serve as the principal utilization management reviewer for cases related to Applied ... medical directors. * Attend and actively participate in clinical meetings with care management and utilization management teams, offering subject matter… more
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