- CVS Health (Lansing, MI)
- …5 years of relevant experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong ... that promote high-quality healthcare for members. **Position Summary** Join our Utilization Management team as a Nurse Consultant, where you'll apply clinical… more
- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... support to the hospital and treatment team throughout the review of patients, their placement in various levels of...and benefits of patients, matching the level of care utilization . Assures compliance with Managed Care Behavioral Health standards… more
- Elevance Health (Indianapolis, IN)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... ** Utilization Management Medical Director - Indiana Medicaid** **Location:**...reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patients receive… more
- Hackensack Meridian Health (Hackensack, NJ)
- **The Per Diem Advanced Practice Nurse (APN) for Utilzation Review utilizes a patient-centered coordinated care model, demonstrating competencies in leadership, ... direct clinical practice, consultation/collaboration, coaching/guiding, research, and ethical decision-making. The APN works collaboratively with the practice/hospital team to assess, plan, and implement care for individuals with health and safety needs.… more
- CVS Health (Phoenix, AZ)
- …partial hospitalization and intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + ... for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team....a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams… more
- Elevance Health (Tampa, FL)
- …physical and/or behavioral health practitioners responsible for coordinating member service, utilization , access, care management and/or concurrent review to ... an accommodation is granted as required by law. *Must reside in the state of Florida* The **Manager of Utilization Management** is responsible for managing a team of… more
- Amergis (Santa Rosa, CA)
- …+ Master's degree in Social Work from a school of social work accredited by the Council on Social Work Education required + Active license as an LCSW in state of ... The Licensed Clinical Social Worker collaborates with the multi-disciplinary team to provide input in the development of the plan of care for those patients/clients requiring social work intervention. The Licensed Clinical Social Worker provides counseling and… more
- Dartmouth Health (Lebanon, NH)
- …* Works with Medical Director and appropriate physician(s) to establish Dartmouth-Hitchcock (D-H) ambulatory and inpatient procedure list, updates and maintains list. ... Overview Works with physicians and multidisciplinary team members to develop a plan of care for assigned patients. Ensures patient is progressing towards desired outcomes by monitoring care through assessments and/or patient records. Identifies and resolves… more
- South Middlesex Opportunity Council (Framingham, MA)
- …individuals, children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. ... and in a timely fashion, for the RRS and outpatient clinic programs. + Review denials and partially paid claims and resolve discrepancies. + Assist in resolving… more