- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… 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
- Tufts Medicine (Burlington, MA)
- … Review and Discharge Planning including implementation and annual review of the Utilization Management Plan and assisting with the coordination of the ... Utilization Management Committee. The Utilization Management Operations Manager follows the system's Utilization Program that integrates the functions… more
- Centene Corporation (Austin, TX)
- …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
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... compliance reviews as needed. + Continuously monitors regulatory requirements for Utilization Management . + Attends Mandatory Education programs required by… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- Intermountain Health (Las Vegas, NV)
- …interacts with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management , care management , claims, network management ... finance. As the Medical Director for Utilization Management , you are responsible, in partnership with MG Clinical...timely documentation and reporting. + Demonstrated knowledge of case management , utilization management , quality … more
- Commonwealth Care Alliance (Boston, MA)
- …& Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the ... and facilities under the provisions of CCA's benefits plan. The Manager, Utilization Management is responsible for overseeing and managing the daily operation of… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Services As Needed / ... + FTE:0.01 + Posted:May 15, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale ... organization, professional organizations, and community health care facilities concerning Utilization Management . + Participates in in-services and continuing… more
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