- LA Care Health Plan (Los Angeles, CA)
- Supervisor , Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM)...in Nursing Experience Required: Minimum of 7 years of acute/ clinical care experience. Minimum of 2 years of experience… more
- AmeriHealth Caritas (Washington, DC)
- …ON BONUS** **Role Overview:** Under the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Centene Corporation (New York, NY)
- …**Must have an active New York State RN license.** **Inpatient Utilization Management ** **Position Purpose:** Supervises Prior Authorization, Concurrent Review, ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to ... staff, members and providers. + Provides backup for the Supervisor , whenever necessary. Participates in the orientation of new...Bachelors degree preferred. + Minimum of three years of clinical experience required. Utilization Management … more
- AmeriHealth Caritas (Lafayette, LA)
- **Role Overview:** Under the direction of a supervisor , the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient ... based on clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of services, identifies… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- Ventura County (Ventura, CA)
- …as needed for outside services for patients/families; + Conducts daily clinical reviews for utilization /quality management activities based ... Senior Registered Nurse - Hospital Management Utilization Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5061650) Apply ...+ Preceptor Pay - $2.50 per hour + House Supervisor Pay - $4.00 per hour + Charge Nurse… more
- Saint Francis Health System (OK)
- …placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the ... and on weekend days.** Job Summary: Provides administrative and clinical support to the hospital and treatment teams throughout...nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location:… more
- Saint Francis Health System (Tulsa, OK)
- …not all inclusive nor does it prohibit the assignment of additional duties. Utilization Management - Laureate Campus Location: Tulsa, Oklahoma 74136 **EOE ... through Friday, 8:00 am to 5:00 pm** Job Summary: Provides administrative and clinical support to the hospital and treatment team throughout the review of patients,… more
- Providence (Anaheim, CA)
- **Description** Under the direction of the Utilization Supervisor / Manager, this position is responsible for the distribution, review, accurate and timely ... (CMA) upon hire. + 1 year - Experience in utilization management or case management ...the California Fair Chance Act." **About the Team** Providence Clinical Network (PCN) is a service line within Providence… more
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