- Centene Corporation (Sacramento, CA)
- …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
- UNC Health Care (Morrisville, NC)
- …the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible ... for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a complex academic health system and… more
- Centene Corporation (Sacramento, CA)
- …experience with prior auth is highly preferred** **Position Purpose:** Directs the utilization management team to ensure the appropriate application of policy ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… more
- Commonwealth Care Alliance (Boston, MA)
- …care operations experience, including a minimum five (5) years of leadership experience in Utilization Management (UM) or nursing leadership to include a ... Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …VA Nurse Total Rewards The Utilization Management /Float Registered Nurse is located at the Nursing , Perioperative service at the Miami VAHCS and ... VA medical Center is looking for recruit for Registered Nurse - Utilization Management /... management practices to ensure efficient resource utilization . Assist in directing the provision of nursing… more
- Alameda Health System (Oakland, CA)
- … Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + Posted:March ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...in Nursing Preferred Education: Master's degree in Nursing Required Experience: Three years of utilization … more
- AmeriHealth Caritas (Lafayette, LA)
- **Role Overview:** Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services, ... making determinations based on clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of services,… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Manager, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support ... Responsibilities + Coordinate day to day operations of the Utilization Management team. + Serve as the...Qualifications + Active and unrestricted license as a Registered Nurse (RN) + Bachelor's degree in nursing ,… more
- Access Dubuque (Dubuque, IA)
- …Butler/ SISCO Utilization Management Assistant Cottingham & Butler/ SISCO Utilization Management Nurse Cottingham & Butler/ SISCO Condition ... Utilization Management CNA **Cottingham & Butler/...will also triage the call to determine if a Utilization Review Nurse is needed to complete… more
- 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: Full ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for...other duties as assigned. Education Required Associate's Degree in Nursing Education Preferred Bachelor's Degree in Nursing … more
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