- Commonwealth Care Alliance (Boston, MA)
- …Knowledge, Skills & Abilities (must have): - Expertise in managing utilization review processes including prior authorization, concurrent and retrospective ... facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing...for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …+ Minimum 3 years of experience in Managed Care, Provider Office, or Utilization Review organization required. + Knowledge of Commercial, Medicare, and Medi-Cal ... **Overview** BroadPath is seeking a highly motivated and results-oriented ** Utilization Management (UM) Nurse** . Our ideal **UM Nurse** will ensure timely review… more
- Daiichi Sankyo, Inc. (Bernards, NJ)
- …involves working with suppliers and internal stakeholders to define scope and review of work orders and agreements, Mitigates supplier issues, develops action plans ... intelligence and trends, to help inform Business budgeting and supplier utilization decisions- Partners with senior business stakeholders across functions to… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- **Join the BlueCare team at BCBST as a Clinical Review Manager \!** In this role, you will complete medical reviews for utilization management within the ... You'll have the opportunity to collaborate with the BlueCare Utilization Management team, Case Managers, and other departments\. The...a compressed work schedule\. - For example, the Clinical Review Manager may work five 8\-hour shifts… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... Case Manager - Per Diem **Position Summary** At Stony...cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to… more
- Commonwealth Care Alliance (Boston, MA)
- 011150 CCA-Network Contracting **Position Summary:** The LTSS Program Manager is responsible for overseeing relationships and performance with community-based ... alignment with CCA's model of care and strategic objectives. The Manager fosters effective clinical and programmatic collaboration with provider partners,… more
- Commonwealth Care Alliance (Boston, MA)
- …Position Summary: The Behavioral Health (BH) Provider Engagement Program Manager is responsible for cultivating strong, collaborative relationships with behavioral ... mission and supporting high-quality, coordinated care for members. In this role, the Program Manager acts as an account manager , relationship manager , and… more
- National Youth Advocate Program (Columbus, OH)
- ** Utilization Manager /Continuous Quality Improvement Manager - Columbus** **Compensation:** $82,000 - $85,000 **Position Summary** The Utilization ... 401K Matching flexible hours, mileage reimbursement, phone allowance **Responsibilities** The Utilization Manager /Continuous Quality Improvement Manager will… more
- Home Depot (Richmond, VA)
- **Position Purpose:** The District Asset Protection Manager (DAPM) is responsible for teaching, coaching, and training associates to ensure the effective execution ... be able to multi-task across stores and gain the partnership of the District Manager , Store Manager , Store Leadership Team, APS and other store associates to… more
