- Wellpath (Freehold, NJ)
- …role** The Medical Director of Utilization Management leads and oversees utilization review , case management, quality improvement, and related policy and ... efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of ...utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external… more
- Waystar (Atlanta, GA)
- …end user adoption of best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as an integral contributor in ... **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer...acute care setting + 2+ years of experience in utilization management + Knowledge and understanding of Utilization… more
- AmeriHealth Caritas (Washington, DC)
- …to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... criteria + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment + Proficiency in MS Office to include… more
- Intermountain Health (Las Vegas, NV)
- …Care Management I leads and collaborates with care management operations across utilization review , acute and emergency department care, and ambulatory/community ... Qualifications** + Previous management experience in hospital care management, utilization review , ambulatory care management, ambulatory utilization… more
- Highmark Health (Harrisburg, PA)
- …+ Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization Review experience **LICENSES AND CERTIFICATIONS** **Required** + Current ... Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… more
- CVS Health (Frankfort, KY)
- …with heart, each and every day. **Position Summary** This is a fully **remote** Utilization Review Clinical Consultant. **Must reside in the state of Kentucky or ... the standard schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Foster Care population experience +… more
- Humana (Jackson, MS)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- UCLA Health (Los Angeles, CA)
- …+ experience in an HMO environment + Thorough knowledge of health care industry, utilization review , utilization management, and concurrent review ... all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll provide direct management to a team of UM coordinators and… more
- Hartford HealthCare (Willimantic, CT)
- …clinical nursing required. * Two years experience with case management, discharge planning, utilization review and/or home care required. * Knowledge of the ... Works under the direction of the Manager of Continuing Care and Utilization Management and in collaboration with physicians, social services, and other hospital… more
- Liberty Healthcare Corporation (Salisbury, MD)
- …are living with developmental disabilities + Service coordination + Case management + Utilization review + Prior authorizations + Claims reviews + Healthcare ... this initiative, Liberty is now hiring for a full-time Utilization Reviewer position. As a Utilization Reviewer,...a full-time Utilization Reviewer position. As a Utilization Reviewer, your daily work will involve: + Conducting… more