- Centene Corporation (Columbus, OH)
- …IN STATE OF OHIO IDEAL CANDIDATE WILL HAVE PRIOR AUTHORIZAION OR UTILIZATION MANAGEMENT EXPERIENCE PEOPLE LEADER EXPERIENCE STRONGLY PREFERRED **Position ... to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team ... internal partners (eg, Provider Relations, Quality) to resolve escalations and address utilization management issues. + Represent UM nursing team in internal… more
- Molina Healthcare (NM)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- Molina Healthcare (San Diego, CA)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- AmeriHealth Caritas (Washington, DC)
- …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Rady Children's Hospital San Diego (San Diego, CA)
- JOB SUMMARY: Under the supervision of the Utilization Management (UM) Operations Supervisor , the UM Coordinator I's primary job function is to support UM ... operations by performing any non-clinical tasks. This includes, but is not limited to, initial authorization processing, (data entry, eligibility verification, benefits verification, and requesting required supporting documents from submitting provider… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print... Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 - $167,136.48 Annually Location Los… more
- Hackensack Meridian Health (Edison, NJ)
- …a leader of positive change. The role of ** Supervisor , Care Management ** integrates and coordinates utilization management , care coordination, discharge ... acute care setting. + Familiar with hospital resources, community resources, and/or resource/ utilization management . + Care coordination, case management or… more
- Veterans Affairs, Veterans Health Administration (Fort Meade, SD)
- …are not limited to, monitoring their own workload and clinical volume. Assists OT supervisor in utilization and management of available space for current, ... and solve problems in order to meet multiple deadlines. Assists the OT Supervisor in utilization review activities, quality improvement, and other administrative… more
- 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