- Fallon Health (Worcester, MA)
- …call center setting or physician's office; knowledge of managed care and/or utilization management strategies advisable + Excellent writing skills with ... FH members and/or provider offices and FH with their authorization management issues. Thorough research, documentation, and corrective action planning must be… more
- Veterans Affairs, Veterans Health Administration (Glendale, CO)
- …skills Possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... CONTINUOUS ANNOUNCEMENT. Applications will be accepted on an ongoing basis. Initial review will be conducted approximately 12/9/25. Then, eligible applicants will be… more
- University of Maryland, Baltimore (Baltimore, MD)
- …related to the delivery of medical care and clinical services such utilization review , quality assurance, policies, procedures and guidelines development. 3. ... managed by University of Maryland Medical Center (UMMC). 8. Provides oversight of utilization and risk management activities including monitoring of service … more
- Centene Corporation (Olympia, WA)
- …duties, scope and skill reflective of the level of this position. Utilization management and clinical experience preferred. Supervisory and/or leadership ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Luke Staffing (Bethesda, MD)
- …+ Comply with regulatory, MTF, and Joint Commission quality inspection/ peer review / utilization management requirements, and applicable system applications. ... and able to work with various personalities. Team work skills required. Time management skills required. The ability to meet deadlines in a deadline intensive… more
- Luke Staffing (Fort Bragg, NC)
- …+ Comply with regulatory, MTF, and Joint Commission quality inspection/ peer review / utilization management requirements, and applicable system applications. ... and able to work with various personalities. Team work skills required. Time management skills required. The ability to meet deadlines in a deadline intensive… more
- Elevance Health (Atlanta, GA)
- …services only, and there is licensed staff supervision. + Previous experience in case management / utilization management with a broad range of experience with ... facility-based and outpatient professional treatment health benefits through telephonic or written review . Primary duties may include but are not limited to: + Uses… more
- Luke Staffing (Fort Bragg, NC)
- …+ Comply with regulatory, MTF, and Joint Commission quality inspection/ peer review / utilization management requirements, and applicable system applications. ... and able to work with various personalities. Team work skills required. Time management skills required. The ability to meet deadlines in a deadline intensive… more
- Veterans Affairs, Veterans Health Administration (Ann Arbor, MI)
- …RN possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting.… more
- UnityPoint Health (Waterloo, IA)
- …patient population, ensuring that adequate discharge plans are in place and completing utilization management and quality review activities. Care is provided ... Sign On Bonus: $7,500 + FTE/Hours per pay period: 0.9 + Department: Case Management + Shift: Mon-Friday, 0800-1630, some weekends and one holiday/year. + Job ID:… more