• Supervisor , Utilization

    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
    LA Care Health Plan (06/13/25)
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  • Supervisor , Utilization

    Centene Corporation (Jefferson City, MO)
    …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
    Centene Corporation (06/25/25)
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  • Supervisor Utilization

    Excellus BlueCross BlueShield (Buffalo, NY)
    …coordinates and is accountable for the daily work of employees who provide utilization management , clinical and medical necessity claim related services and ... PT, NP, PA, or Dietician) with a minimum of three years of utilization management /quality improvement experience or equivalent required. + Must possess a… more
    Excellus BlueCross BlueShield (06/05/25)
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  • Supervisor , Behavioral Health…

    Centene Corporation (Tallahassee, FL)
    …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
    Centene Corporation (06/26/25)
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  • UM Supervisor (RN)

    Amergis (Rancho Cordova, CA)
    Salary: $1760 / Week Supervisor Utilization Management PriorAuthorization Anticipated Duration: ASAP - 3 monthcontract Location Address: Rancho Cordova CA ... management experiencerequired Amergis Healthcare Staffing is seeking a Supervisor Utilization Management Prior Authorization responsible… more
    Amergis (06/06/25)
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  • RN Supervisor UM Prior Auth

    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
    Dignity Health (06/20/25)
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  • Utilization Management Review Nurse

    AmeriHealth Caritas (LA)
    …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... and efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon to: + Conduct utilization more
    AmeriHealth Caritas (06/25/25)
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  • Utilization Management Review Nurse

    AmeriHealth Caritas (Washington, DC)
    …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs **Responsibilities** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
    AmeriHealth Caritas (06/03/25)
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  • Physician Advisor

    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
    WellSpan Health (05/09/25)
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  • Utilization Review Nurse Supervisor

    The County of Los Angeles (Los Angeles, CA)
    UTILIZATION REVIEW NURSE SUPERVISOR I Print... Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply  UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 - $167,136.48 Annually Location Los… more
    The County of Los Angeles (05/22/25)
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