- Humana (Oklahoma City, OK)
- …health first** The UM Administration Coordinator 2 contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… more
- Monte Nido (Eugene, OR)
- …continuity of care + Communicate with insurance providers for **pre-certification and utilization review ** + Collaborate on **discharge and aftercare planning** ... continuous care. + Communicate with insurance companies for pre-certification and ongoing utilization management needs. + Participate in discharge planning and… more
- Molina Healthcare (OH)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... JOB DESCRIPTION Job Summary The Care Review Clinician RN provides support for clinical member...program(s) proficiency. Preferred Qualifications * Certified Professional in Healthcare Management (CPHM). * Recent hospital experience in an intensive… more
- Molina Healthcare (OH)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- Molina Healthcare (Los Angeles, CA)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At ... California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_3-12 NIGHT SHIFT 7:30PM - 08:30AM PACIFIC HOURS NON EXEMPT, 3 days a week will… more
- Trinity Health (Boise, ID)
- …Day Shift **Description:** **GENERAL SUMMARY AND PURPOSE:** Provides hospital case management / utilization review and discharge planning collaboratively ... patient care as appropriate. Coordinates the hospital activities concerned with case management / utilization review and discharge planning. Adheres to… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …will be responsible for establishing imaging protocols; reviewing imaging requests; utilization management ; ensuring appropriate preps and medication are ... section, service or facility level committees/boards, when assigned. Serve as Peer Reviewer for the Protected Peer Review Committee, when assigned. Demonstrate… more
- Molina Healthcare (Sterling Heights, MI)
- JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to utilization management team and contributes to interdisciplinary efforts supporting ... * Provides telephone, clerical and data entry support for the care review team. * Provides computer entries of authorization request/provider inquiries, such as… more
- Centene Corporation (Trenton, NJ)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Prime Healthcare (La Palma, CA)
- …Discharge Plan. Qualifications EDUCATION, EXPERIENCE, TRAINING 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and ... Responsible for the coordination of the various activities of the Case Management Department under the direction of the assigned Case Manager/Social Worker assist… more