- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical… more
- Centene Corporation (Jefferson City, MO)
- …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 + Maintains… more
- Tufts Medicine (Burlington, MA)
- …payment processing. In addition, this role focuses on performing the following Utilization duties: Ensures the delivery of clinical services is appropriate and ... **Job Overview** The position provides day to day support and oversight to Utilization Review departments and UM vendor management. The UM Operations Manager is… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse!Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ensure ... appropriate service utilization . Working under the general supervision of the Director...Medical Directors and other Medical Management staff to direct utilization and capture data effectively. Responsibilities + Review prior… more
- UNC Health Care (Raleigh, NC)
- **Description** **RN Utilization Manager needed to provide per diem coverage on weekends at UNC Rex and UNC Rex Holly Springs.** Become part of an inclusive ... episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to… more
- New York State Civil Service (New York, NY)
- NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), Manhattan Psychiatric Center, P26306 Occupational Category Health Care, ... 10035 Duties Description Manhattan Psychiatric Center is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and… more
- Centene Corporation (Austin, TX)
- …HAVE BCBA CERTIFICATION **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and ... supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review, the Utilization Review Medical Director will be responsible ... for providing leadership and subject matter expertise to our utilization management (UM) group. This role is a key role in helping our organization provide high… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for determining ... with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities for improvement… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I ... comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're working… more
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