- Tufts Medicine (Burlington, MA)
- … review and management . The position develops and leads the Utilization Management operations, strategy and implementation of the Utilization ... of Science in Nursing (BSN). 2.Massachusetts RN Licensure. 3. Current certification in case/ utilization management (ACM, CCM, CMAC) 4. Seven (7) years of UM/Case… 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 ... Friday, an 8-hour shift between 8 am - 8 pm EST. The ** Utilization Management Representative II** is responsible for managing incoming calls, including… 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 ... 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 ... unless an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible for coordinating cases… 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 ... benefits and/or eligibility information. + May act as liaison between Medical Management and internal departments. + Responds to telephone and written inquiries from… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …Oversee and direct work activities of unlicensed clinical staff involved in the utilization management process. + Communicate with ABA providers to gather ... policies. + Participate in the development and refinement of utilization management protocols and clinical review tools....behavioral health settings. _The Physical Demands described here are representative of those that must be met by an… more
- Henry Ford Health System (Troy, MI)
- …well as proponent of the proficiency, abilities and interests of representative department. Develop competency of various corporate databases and establish expertise ... requirements. Minimum 3 years experience in healthcare industry in reporting, data management or analysis. Two or more years experience with relational databases and… more
- University of Rochester (Albany, NY)
- …of Medicare and other payer regulations for the coordination of benefits. + Notify Utilization Management of clinical requests by third party payers. + Maintain ... Counseling, Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management , Utilization Management , Social Work, Patient… more
- Luke Staffing (GU)
- …of clinical nursing experience is required. One year of previous experience in Utilization Management is required. Full time employment in a nursing field ... requirements of this position, it must be directly related to referral/ utilization management . + **Licensure:** Current, full, active, and unrestricted… more
- Fallon Health (Worcester, MA)
- …include products, benefits, claims, referral and eligibility verification processes, utilization management guidelines, etc. Activities include conducting both ... policies and procedures for products, benefits, claims, referral, and eligibility and utilization management . + Co-lead internal and external Joint Operations… more