- Centene Corporation (Richmond, VA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… more
- CVS Health (Springfield, IL)
- …in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds ... 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
- Centene Corporation (Richmond, VA)
- …activities including peer-to-peer requests, authorization entry, and discharge data management . + Leads utilization management team on performance, ... including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of… 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)
- …CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management ( Authorization ) Unit is primarily responsible for ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager, Utilization Management reports to the Director of … more
- Guthrie (Cortland, NY)
- …Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization /certification for ... Summary The LPN Utilization Management (UM) Reviewer, in collaboration...and other hospital departments as appropriate to obtain prior authorization required to meet contractual reimbursement requirements and to… more
- LA Care Health Plan (Los Angeles, CA)
- …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II...the discharge planning process, including providing clinical review and authorization for alternate levels of care, home health, durable… 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 ... retrospective reviews. Primary Responsibilities + Coordinate day to day operations of the Utilization Management team. + Serve as the primary contact for… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... financial, and utilization goals through effective management , communication, and...progressive discipline process when appropriate * Collaborates with department director and professional development specialist to develop standard work… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... admissions and extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key contact for facility… more
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