- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Bring your true colors to blue. The Role:The Medical Clinical Program Manager will focus on utilization management compliance and audit readiness activities ... The Team: As an integral part of HMM Quality and Compliance team, the Clinical Program Manager works through the influence as an individual contributor while… more
- Cedars-Sinai (Santa Monica, CA)
- …providing ongoing direction for system utilization . + Assists the Senior Clinical Operations Manager in developing and managing the budget for responsible ... of patients from around the world who receive treatment here each year. The Manager , MN Clinical Operations supports the safe and effective delivery of patient… more
- UNC Health Care (Chapel Hill, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in… more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing the ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director of … more
- Highmark Health (Sacramento, CA)
- …ability to deliver engaging and informative product demonstrations and walkthroughs. + ** Utilization Management & Clinical Expertise:** + Utilization ... Knowledge: Familiarity with medical terminology, healthcare delivery systems, and clinical guidelines relevant to utilization management. + Healthcare Industry… more
- Beth Israel Lahey Health (Burlington, MA)
- …job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse ... Case Manager for Hospital at Home Care Transitions coordinates utilization review, discharge planning and monitors quality assurance for Lahey Clinic inpatient… 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
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time **Shift:** Day ... : Holy Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management, you will be...and payers, and streamline care plans to align with clinical and regulatory standards. By optimizing resource utilization… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you...UR and the analysis, resolution, monitoring & reporting of clinical denials. + Maintains current knowledge of payer contract… more
- Catholic Health Services (Melville, NY)
- …Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals according to industry ... agencies, as needed or requested. Handles queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals… more
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