- Centene Corporation (Sacramento, CA)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care...holidays, and a flexible approach to work with remote, hybrid , field or office work schedules. Actual pay will… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Inpatient Management Onsite Care Management Supervisor will direct and coordinate the activities of Onsite Care ... a week-to-week basis, management may occasionally approve the onsite care management supervisor to perform limited functions telephonically, at its sole… more
- Actalent (Fort Lauderdale, FL)
- … Utilization Review Nurse Job Description We are seeking a dedicated Utilization Management Nurse (UMN) who will work collaboratively with an ... Prepare and present reports on department activities as assigned. Essential Skills + Utilization management + Behavioral Health + Mental Health + Clinical review… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests for ... reports on department activities as assigned. Essential Skills + Experience in utilization management , behavioral health, and mental health. + Proficiency in… more
- AmeriHealth Caritas (Washington, DC)
- …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- RTX Corporation (Cedar Rapids, IA)
- …400 Collins Rd NE , Cedar Rapids, IA, 52227 USA **Position Role Type:** Hybrid **U.S. Citizen, US Person, or Immigration Status Requirements:** Must be authorized to ... to join our **RTX Enterprise Services** team: The **Senior Supervisor ** is a part of the **Service Center Leadership...and leader guidance related to routine and complex people management activities across all business lines. + Manage day… more
- CareFirst (Baltimore, MD)
- …medical-surgical or similar clinical experience OR 5 years' experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- Child Communication and Behavior Specialists (CA)
- …neurodiversity-affirming, and culturally inclusive environment. The Position We are seeking a Hybrid BCBA Supervisor & Clinical Consultant to join our team. ... conducted in clinics or client homes. As a BCBA Supervisor , you'll: + Deliver impactful caregiver-mediated treatment (CMT). +...and successful client outcomes. + Ensure at least 90% utilization of recommended treatment hours. + Deliver a minimum… more
- Eversource Energy (Plymouth, MA)
- …productivity of district/substation operations\. Responsible for monitoring district performance through utilization analyses\. This is a hybrid role\. The first ... utilization and workload trends and productivity\. Keeps district/substation management informed of results\. + Identifies, develops and implements work process… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions as the ... necessity of outpatient observation and inpatient stays and the utilization of ancillary services + Perform other duties as...services + Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials.… more