- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... who is willing and able to work in a hybrid model. The incumbent will be expected to work...medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care.… more
- Elevance Health (Cincinnati, OH)
- ** Utilization Management Representative II** **Schedule: Monday-Friday 8am-5pm Eastern Time** **Must be located near one of our Ohio PulsePoint offices in ... Mason, Columbus or Seven Hills, Ohio** **Location:** Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring … more
- Baylor Scott & White Health (Dallas, TX)
- …to fit their needs. + Proficiency in discharge planning, setting case management referral standards, reviewing utilization , and categorizing levels of care. ... in Microsoft Office and medical documentation systems. + Case management certifications, such as Certified Case Manager ,...Case management certifications, such as Certified Case Manager , are beneficial but not necessary for this position.… more
- New York State Civil Service (New York, NY)
- NY HELP No Agency Empire State Development, NYS Title Project Manager , Utilization - MWBE Occupational Category Other Professional Careers Salary Grade NS ... the direct supervision of the Director of Contract Participation, the Project Manager , Utilization , will lead the planning, execution, and monitoring of… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 + Clinical knowledge, communication… more
- AmeriHealth Caritas (Philadelphia, PA)
- ; **Responsibilities:** The Medical Director, Utilization Management provides organizational leadership in the operational areas of care management , ... policy and practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The… more
- Elevance Health (Winston Salem, NC)
- ** Utilization Management Medical Director- NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required ... Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May be… more
- Elevance Health (Walnut Creek, CA)
- ** Utilization Management Representative II** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required ... skill development. _Please note that per our policy on hybrid /virtual work, candidates not within a reasonable commuting distance...shift between 8 am - 8 pm EST. The ** Utilization Management Representative II** is responsible for… more
- Elevance Health (Richmond, VA)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... employment, unless an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible for coordinating cases… more
- Elevance Health (Richmond, VA)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... employment, unless an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible for coordinating cases… more
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