- LA Care Health Plan (Los Angeles, CA)
- Supervisor , Utilization Management RN 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 Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day… more
- VNS Health (Manhattan, NY)
- …Will Do + Supervises the day-to-day operations of VNS Health Plans Medical Management clinical and non clinical staff. Makes recommendations to the development, ... utilization , and evaluation of internal processes to ensure customer...in addressing and resolving day-to-day operational issues. + Assists management team in the development of long- and short-… more
- Centene Corporation (Jefferson City, MO)
- …to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... adherence to performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH care member issues related to BH… more
- UCLA Health (Los Angeles, CA)
- …Advantage team, you will be responsible for assisting with the day-to-day management of the UM department and coordinators. This will involve coordinating staff ... schedules to efficiently handle incoming referrals and phone call volume. You will develop workflows, desktop procedures, forms, training materials, and protocols for achieving team objectives and key performance indicators. You will hire and train… more
- Dignity Health (Rancho Cordova, CA)
- …Summary:** Under the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable ... sets (Medicare Guidelines InterQual Health Plan Benefit Interpretation Guidelines and Medical Management Policies and DHMF Utilization Management guidelines… more
- Providence (Everett, WA)
- **Description** The Supervisor for Utilization Management provides a key role in leading, facilitating and managing the hospital utilization ... upon hire + Previous healthcare administration and/or delivery of healthcare services + Utilization Management /Review. + Experience related to a wide variety of… more
- AmeriHealth Caritas (Charleston, SC)
- …about us at www.amerihealthcaritas.com . **Responsibilities:** Under the direction of the Supervisor , the Behavioral Health Utilization Management Reviewer ... years of behavioral health and substance use disorder experience.; + Utilization management experience in a managed care organization preferred. + Proficiency in… more
- AmeriHealth Caritas (Dover, DE)
- …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon to: + Conduct concurrent reviews… more
- WelbeHealth (CA)
- …compliant, and cost-effective care to our participants. By guiding this team, the Utilization Management RN Supervisor drives the continuous improvement of ... a critical role in our participant's journey and our Utilization Management team ensures we can provide...external), clinical staff, and others to timely resolve any utilization management issues **Job Requirements:** + Minimum… more
- WellSpan Health (York, PA)
- …peer cases for need of retrospective external appeal-and funnel those cases to the Supervisor of Utilization Management for expedition. + Reviews cases ... Management staff. Duties and Responsibilities Essential Functions: + Renders utilization management determination in accordance with State and Federal… more
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