- 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
- Fallon Health (Worcester, MA)
- … activities. + Recommends and implements innovative process improvements for the prior authorization and utilization management processes + Develops and ... cost of care opportunities related to Utilization Management . + Works with VP/ Medical Director ...Manages data, predictive analytics to improve efficiency of prior authorization and utilization management +… 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
- CVS Health (Baton Rouge, LA)
- …with heart, each and every day. **Position Summary** The Utilization Management Coordinator/UMNC assists in ensuring that authorization request decisions are ... authorization PAL coordinator's * Facilitate collaboration with medical director , authorization and care management ...children, ie generators, housing, rentals) * Collaborate with care management and utilization management teams… more
- 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
- Integra Partners (Troy, MI)
- …of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, salaried role functions ... The Utilization Review Medical Director is responsible...or past OIG or state sanctions + Experience performing utilization management or clinical review activities +… more
- Healthfirst (NY)
- …to maintain and improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement + Lead ... closely with other Operations leaders including but not limited to Care Management , Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to… 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
- McLaren Health Care (Flint, MI)
- …to help people live healthier and more satisfying lives. We are looking for a Utilization Management RN, to join in leading the organization forward. MHP is a ... our members. **Position** **Summary:** This position is responsible for utilization management functions. This includes but is...This includes but is not limited to review and authorization of services, utilization of medical policy,… 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
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