- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... who is willing and able to work in a hybrid model. The incumbent will be expected to work...business. **Knowledge, Skills and Abilities (KSAs)** + Oversight of Utilization Management clinicians while championing process improvement,… more
- Centene Corporation (New York, NY)
- …**Must have an active New York State RN license.** **Inpatient Utilization Management ** **Position Purpose:** Supervises Prior Authorization, Concurrent Review, ... ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks...holidays, and a flexible approach to work with remote, hybrid , field or office work schedules. Actual pay will… more
- AmeriHealth Caritas (Lafayette, LA)
- **Role Overview:** Under the direction of a supervisor , the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient ... making determinations based on clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of services,… more
- CareFirst (Baltimore, MD)
- …County/Washington DC or Northern Virginia metropolitan area.** **PURPOSE:** The Inpatient Management Care Management Supervisor will direct and ... a week-to-week basis, management may occasionally approve the onsite care management supervisor to perform limited functions telephonically, at its sole… more
- Saint Francis Health System (Tulsa, OK)
- …placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the ... needed by the department; limited benefit offerings. Nights \#ALDIND HYBRID ROLE AND REQUIRES CANDIDATE TO BE LOCAL TO...nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location:… more
- CareFirst (Baltimore, MD)
- …medical-surgical or similar clinical experience OR 5 years experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- AmeriHealth Caritas (LA)
- …Under the direction of the Supervisor , the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity ... using InterQual and American Society of Addiction Medicine (ASAM) criterion + Utilization management experience within a managed care organization desired +… more
- Child Communication and Behavior Specialists (CA)
- …neurodiversity-affirming, and culturally inclusive environment. The Position We are seeking a Hybrid BCBA Supervisor & Clinical Consultant to join our team. ... conducted in clinics or client homes. As a BCBA Supervisor , you'll: + Deliver impactful caregiver-mediated treatment (CMT). +...and successful client outcomes. + Ensure at least 90% utilization of recommended treatment hours. + Deliver a minimum… more
- Eversource Energy (Plymouth, MA)
- …productivity of district/substation operations\. Responsible for monitoring district performance through utilization analyses\. This is a hybrid role\. The first ... utilization and workload trends and productivity\. Keeps district/substation management informed of results\. + Identifies, develops and implements work process… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions as the ... necessity of outpatient observation and inpatient stays and the utilization of ancillary services + Perform other duties as...services + Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials.… more
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