- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support staff from ... onboardings with time sensitive requirements. + Support and grow the utilization management team through strong professional relationships, mentorship, modelling of… more
- Molina Healthcare (GA)
- …performance of one or more of the following activities: care review , care management, utilization management (prior authorizations, inpatient/outpatient medical ... in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS),… more
- Humana (Lincoln, NE)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Molina Healthcare (GA)
- …services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team ... of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral… more
- Humana (Augusta, ME)
- … Nurse (RN) license in the state of Michigan. + Previous experience in utilization management and/or utilization review . + Minimum of two (2) years ... of our caring community and help us put health first** The Manager, Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical nursing… more
- CareFirst (Baltimore, MD)
- …required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership experience. ... **Resp & Qualifications** **PURPOSE:** Manages the utilization of referral services. Enhances quality of care by assuring compliance with policies, including safety,… more
- CVS Health (Columbus, OH)
- …or experience. Must reside in the state of Ohio. + Managed care/ utilization review experience + Be clinically and culturally competent/responsive with ... Summary** The Behavioral Health UM Clinician position is designed to clinically review of behavioral health prior authorized services for assigned members. This… 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
- 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