- Tufts Medicine (Burlington, MA)
- …assisting with the coordination of the Utilization Management Committee. The Utilization Management Operations Manager follows the system's ... This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In... Utilization Management Plan and… more
- Centene Corporation (Olympia, WA)
- … management issues related to member care, provider interactions, and facilitates operations within utilization management . + Manages prior authorization, ... compliance with applicable guidelines, policies, and procedures + Reviews and analyzes utilization management activities, operations , costs, and forecasted… more
- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Manager , Behavioral Health Utilization Management uses clinical knowledge, communication ... department. **_Detailed Responsibilities include:_** Leads Kentucky Medicaid Behavioral Health Utilization Management process and teams responsible for… more
- CoreCivic (Brentwood, TN)
- …position will pay $82,000 - $97,400 with a 10% bonus eligible._ **SUMMARY:** The Manager , Utilization Management /Case Management provides Utilization ... services for select patient populations. Assists with daily hospital case management operations and is accountable for achieving established outcomes… more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** Hybrid work schedule available. Monday-Friday, 8:00AM-4:30PM. + **Hospital:** Ascension St. ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… more
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered...presents areas for innovation, efficiency and improvement in case management or department operations using evidence-based practice… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for... (UM) RN is responsible for executing the day-to-day operations of the UM department, and monitoring the Care… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …knowledge of health plan operations , clinical issues, trends and medical management , utilization management , quality management , contracting, ... nurses working with the Rady Children's Health Network. The Utilization Management Medical Director will collaborate closely...remain open from the "date posted" until the hiring manager has determined there is a sufficient applicant pool… more
- McLaren Health Care (Detroit, MI)
- **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the coordination of patient admission and continued stay ... observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure that… more
- AmeriHealth Caritas (Newtown Square, PA)
- …more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director, Utilization Management provides organizational leadership in the ... policy and practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The… more