- VitalCore Health Strategies (Munising, MI)
- …clinical quality and integrity of patient medical care including oversight of utilization and quality management , credentialing, and best practice guideline ... in correctional healthcare, has an opening for a Hub Director - Upper Regional Medical Director - Upper Peninsula...medical care. This includes, but is not limited to, authorization of services, consultation to clinical operations and overall… more
- Centene Corporation (Richmond, VA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… more
- Fallon Health (Worcester, MA)
- … activities. + Recommends and implements innovative process improvements for the prior authorization and utilization management processes + Develops and ... cost of care opportunities related to Utilization Management . + Works with VP/ Medical Director ...Manages data, predictive analytics to improve efficiency of prior authorization and utilization management +… more
- CVS Health (Springfield, IL)
- …in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds ... 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
- CVS Health (Baton Rouge, LA)
- …with heart, each and every day. **Position Summary** The Utilization Management Coordinator/UMNC assists in ensuring that authorization request decisions are ... authorization PAL coordinator's * Facilitate collaboration with medical director , authorization and care management ...children, ie generators, housing, rentals) * Collaborate with care management and utilization management teams… more
- Centene Corporation (Richmond, VA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… more
- Integra Partners (Troy, MI)
- …of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, salaried role functions ... The Utilization Review Medical Director is responsible...or past OIG or state sanctions + Experience performing utilization management or clinical review activities +… more
- Healthfirst (NY)
- …to maintain and improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement + Lead ... closely with other Operations leaders including but not limited to Care Management , Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to… more
- Guthrie (Cortland, NY)
- …Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization /certification for ... Summary The LPN Utilization Management (UM) Reviewer, in collaboration...and other hospital departments as appropriate to obtain prior authorization required to meet contractual reimbursement requirements and to… more
- McLaren Health Care (Flint, MI)
- …to help people live healthier and more satisfying lives. We are looking for a Utilization Management RN, to join in leading the organization forward. MHP is a ... our members. **Position** **Summary:** This position is responsible for utilization management functions. This includes but is...This includes but is not limited to review and authorization of services, utilization of medical policy,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... financial, and utilization goals through effective management , communication, and...progressive discipline process when appropriate * Collaborates with department director and professional development specialist to develop standard work… more
- Intermountain Health (Las Vegas, NV)
- …of hire or promotion. + Demonstrated care management experience. + Authorization or Utilization Management experience. + Leadership experience. ... work and complex care planning, transitions of care, and utilization management . The position ensures compliance with...Care Management I reports to the Care Management Director . **Position Details** + Full Time… more
- Saint Francis Health System (OK)
- …placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the ... not all inclusive nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location: Virtual Office, Oklahoma 73105… more
- Integra Partners (Troy, MI)
- … Director ) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES ... claims platform + Verify all necessary documentation has been submitted with authorization requests + Contact requesting providers to obtain medical records or other… more
- Community Health Systems (Franklin, TN)
- …preferred **Knowledge, Skills and Abilities** + Strong knowledge of utilization management principles, payer requirements, and healthcare regulations. ... Summary** The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals… more
- Community Health Systems (Naples, FL)
- …decisions regarding medical necessity and care status. + Proficient in utilization review processes, admission criteria, and payer authorization requirements. ... Join us as a **Registered Nurse (RN) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is an onsite… 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 ... admissions and extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key contact for facility… more
- Integra Partners (Troy, MI)
- …experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key ... role in collaborating with our Medical Director to perform benefit and medical necessity reviews and...limited to: + Perform pre-service and post service UM authorization reviews utilizing federal and state mandates, plan benefit… more
- Centene Corporation (New York, NY)
- …and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Sharp HealthCare (San Diego, CA)
- …or services, readmissions to acute or visit to the Emergency Department.Informs Director , QI/UM of any quality issues.Attends hospitalists rounds, as required, to ... discuss high risk patients requiring case management follow up.Attends clinical in-services or required operational/clinical training sessions. + Act as a… more
