- 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
- 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
- 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
- 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
- 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
- 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
- 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 (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
- 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
- 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
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