- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing the ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director of … more
- Veterans Affairs, Veterans Health Administration (Houston, TX)
- Summary The Registered Nurse Quality & Patient Safety Nurse Manager - Utilization Management functions as a clinical expert and is responsible and ... qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Preferred Experience: 1-3 years Utilization Management, Nurse Case Manager /Caseworker, and/or Process… more
- State of Indiana (Indianapolis, IN)
- …of three (3) years of staff management and evaluation experience; clinical experience in managed care and accredited utilization management experience ... Utilization Management Manager Date Posted: Jul...provides the skills needed to conduct oversight of all utilization management practices and clinical criteria evaluations.They… more
- J&J Family of Companies (Cincinnati, OH)
- …United States of America **Job Description:** Johnson & Johnson is recruiting for a ** Clinical Evaluation Project Manager ** to join our MedTech Surgery ... help patients on their journey to wellness. Learn more at https://www.jnj.com/medtech The Clinical Evaluation Project Manager acts as the project management… more
- J&J Family of Companies (Raritan, NJ)
- …all applications will be considered.** We are searching for the best talent for ** Clinical Evaluation Project Manager ** to be in **Raritan, New Jersey** ... . **JOB SUMMARY** The Clinical Evaluation Project Manager acts...role focuses on process optimization and the deployment and utilization of consistent project management methodologies supporting key planning… more
- Phoenix House (Wainscott, NY)
- ** Utilization Review Manager ** **Job Details** **Job.... Initiate and resolve appeals . Work with the clinical and nursing teams to obtain up to date ... Morning **Job Category** Nonprofit - Social Services **Description** **SUMMARY** The Utilization Review (UR) Manager coordinates commercial, and Medicaid Managed… more
- Veterans Affairs, Veterans Health Administration (Houston, TX)
- …standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Preferred Experience: 1-3 years Utilization Management, Nurse Case Manager /Caseworker and ... healthcare settings. Knowledge and ability to apply InterQual criteria, utilization management process, clinical documentation requirements, current standards… more
- Commonwealth Care Alliance (Boston, MA)
- …quality. + Interface with Primary/Interdisciplinary Care Team including Care Coordinator, Care Manager , and others to consult on clinical decision making, ... in behavioral health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred **Required Knowledge,… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- …and collaboration to promote improvements in patient care through systematic evaluation and analytical review of clinical information. Responsibilities ... Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the revenue cycle… more
- AdventHealth (Altamonte Springs, FL)
- …893 Hope Way Altamonte Springs, FL 32714 **The role you'll contribute:** The Clinical Resource Manager provides leadership and consultation to company facilities ... in the clinical review, evaluation and procurement of products... of products and services + Reports to Senior Clinical Resource Manager and collaborates on implementation… more
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