- Centene Corporation (Sacramento, CA)
- … Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- CareFirst (Baltimore, MD)
- …programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Utilization Management **Equal Employment ... **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination… more
- US Tech Solutions (Canton, MA)
- …**Job Descriptions** + Under the direction of the Pharmacy Utilization Management (UM) Supervisor , the Clinical Pharmacist is responsible for ... experience as a Prior Authorisation Pharmacist in a managed care setting + Utilization Management experience is required. **Education:** + Degree in Pharmacy or… more
- Point32Health (MA)
- …. **Job Summary** Under the direction of the Pharmacy Utilization Management (UM) Supervisor , the Clinical Pharmacist is responsible for ... authorization (PA) requests for coverage determinations (CD), and exceptions. The Clinical Pharmacist ensures timely disposition of reviews for CD and exceptions… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to ... staff, members and providers. + Provides backup for the Supervisor , whenever necessary. Participates in the orientation of new...Bachelors degree preferred. + Minimum of three years of clinical experience required. Utilization Management … more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- Saint Francis Health System (OK)
- …placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the ... not all inclusive nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location: Virtual Office, Oklahoma 73105… more
- Covenant Health Inc. (Knoxville, TN)
- …audits thus promoting a culture of professional expertise in utilization management . + Provides monitoring and oversight of non- clinical utilization ... Overview Registered Nurse Utilization Management Full Time, 80 Hours...and written communication skills in order to clearly present clinical and financial data to various audiences as necessary.… more
- AmeriHealth Caritas (LA)
- …Under the direction of the Supervisor , the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity ... reviews. Using clinical knowledge and experience, the clinician reviews provider requests...and American Society of Addiction Medicine (ASAM) criterion + Utilization management experience within a managed care… more
- Helio Health Inc. (Syracuse, NY)
- …Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management ... track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our Inpatient,… more
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