- Cleveland Clinic (Cleveland, OH)
- …career with one of the most respected healthcare organizations in the world. As a Utilization Management Specialist , you will perform UM activities, such as ... discharge plan. + Achieve a minimum of 85% on IRR quarterly. + Complete Utilization Management for assigned patients with a minimum of 25-30 reviews per day. +… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- TEKsystems (Los Angeles, CA)
- …- 3 days remote and 2 on-site (Tues/Thurs). M-F 8am - 5pm.Position Overview The Utilization Management Specialist plays a critical role within the Quality ... Management department, serving as the last line of defense for claims that have been denied. This position is responsible for researching denied claims, gathering necessary information, and facilitating resubmission to Health Plans. The ideal candidate will… more
- Common Ground (Flint, MI)
- Exciting Career Opportunity! The Behavioral Health Utilization Management (UM) Specialist is responsible for reviewing and evaluating mental health and ... MLP) required. Experience + 2+ years in behavioral health clinical practice and/or utilization management . + Minimum of 3 years in diagnosing, treating people… more
- Spectrum Billing Solutions (Skokie, IL)
- …mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist | Revenue ... Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health Billing … more
- AnMed Health (Anderson, SC)
- Responsible for performing daily operations of Utilization Management (UM) program including certification management , medical necessity determinations, ... performance tracking and regulatory compliance. Qualifications: Requires current SC RN. Minimum of two years of clinical experience required. UM experience preferred but not required. more
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
- LA Care Health Plan (Los Angeles, CA)
- …to achieve that purpose. Job Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and ... Authorization Technician II (12 Month Assignment) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type:… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... **Job Summary** The Clinical Utilization Review Specialist is responsible for...extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key… more
- CaroMont Health (Gastonia, NC)
- …to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments, ... liaison to managed care organizations. Communicates with attending physicians regarding utilization issues. Collaborates with discharge planning specialist and… more
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