- 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
- AmeriHealth Caritas (Lafayette, LA)
- **Role Overview:** Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient ... and making determinations based on clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of… more
- Centene Corporation (New York, NY)
- …an active New York State RN license.** **Inpatient Utilization Management ** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials … 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...Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… more
- Access Dubuque (Dubuque, IA)
- …Utilization Management Assistant answers first level calls in Utilization Review for HealthCheck360 participants. They will evaluate certification ... Utilization Management CNA **Cottingham & Butler/... Utilization Management CNA **Cottingham & Butler/ SISCO** 1 Positions...will also triage the call to determine if a Utilization Review Nurse is needed to complete… more
- UPMC (Pittsburgh, PA)
- …and full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including ... MD or DO for a fully remote Medical Director, Utilization Management role. The Medical Director, ...and potential quality of care concerns. + Provide expedited review and determination of medically pressing issues in accordance… more
- McLaren Health Care (Port Huron, MI)
- **Department:** Utilization Review **Daily Work Times:** 8:00am-4:30pm **Hours Per Pay Period:** 40 **Position Summary:** Responsible for determining the ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- Commonwealth Care Alliance (Boston, MA)
- …and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
Related Job Searches:
Management,
Nurse Utilization Management Reviewer,
RN Utilization Management Reviewer,
Reviewer,
Utilization,
Utilization Management,
Utilization Management Reviewer Behavioral