- Centene Corporation (Westmont, IL)
- …given to applicants who (1) reside in Illinois and have experience with (2) utilization management , authorizations or managed care . Additional Details: * ... workplace flexibility. NOTE: This fully remote role involves completing utilization management related tasks for LTSS waiver...guidelines. + Provides outreach to members via phone to support with care plan next steps, community… more
- Molina Healthcare (San Francisco, CA)
- …Health or related field. **Preferred Experience** + 5 years clinical practice with managed care , hospital nursing or utilization management experience. + 3+ ... Care (MCO) **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM), Certified Professional in… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily ... under the provisions of CCA's benefits plan. The Manager, Utilization Management is responsible for overseeing and...relations, case management and quality teams to support care coordination and integrated care… more
- LA Care Health Plan (Los Angeles, CA)
- …of work/licensure. The Supervisor is a subject matter expert (SME) in Care /Case/ Utilization Management and supporting regulations, policies, protocols, and ... County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.... experience. Minimum of 2 years of experience in Case/ Care / Utilization Management in an acute… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II...Management or CM. Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and Medicaid… more
- Trinity Health (Albany, NY)
- **Employment Type:** Part time **Shift:** Day Shift **Description:** **RN for Utilization Management - Per Diem** **St. Peter's Hospital in Albany, NY** is ... an experienced RN to work as a Registered Professional Utilization Management Nurse (UMRN) per diem. The...We recognize the crucial role you play in the care of every patient treated and we have worked… more
- Hackensack Meridian Health (Brick, NJ)
- …to transform healthcare and serve as a leader of positive change. The ** Care Management , Care Coordinator, Utilization Management ** is a member of ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …coding standards + Maintains current and working knowledge of Utilization Management Standards. + Experience in interpreting managed care benefit plans and ... customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough...of care . + Collaborates with hospital, home care , care management , and other… more
- Ventura County (Ventura, CA)
- …needs; + Coordinates the interdisciplinary approach to providing continuity of care , including Utilization management , Transfer coordination, Discharge ... Per Diem Registered Nurse II/III - Utilization Management VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply Per Diem… more
- CommonSpirit Health (Phoenix, AZ)
- …ensuring the organization remains at the forefront of industry best practices in utilization management and patient care . **Essential Key Responsibilities:** ... **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of...and insurance representatives to resolve issues related to coverage, care management , and treatment options. Act as… more