- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …operations. The Supervisor of the UM Coordinator reports to the UM Manager and/or Director of Clinical Programs. Primary Responsibilities * Supervises ... Managers and Sales teams to gather feedback to enhance service performance. * Participate in activities designed to improve...and client satisfaction and business performance. * Works with UM Manager and/or Director to identify performance… more
- Integra Partners (Troy, MI)
- …educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes. The ... a strong nursing background combined with expertise in clinical documentation, medical necessity determination, regulatory compliance, and will be responsible for… more
- Elevance Health (Durham, NC)
- …and depression, and insightful analytics to improve the delivery of care. **BH Care Manager I, UM /Crisis Line - North Carolina** Candidate must live AND be ... pm (EST) and Rotating Holiday coverage.** The **BH Care Manager I, UM /Crisis Line** is responsible for...line calls strongly preferred.** + Applied Behavioral Analysis (ABA) Services (BCBA). Please be advised that Elevance Health only… more
- Humana (Columbus, OH)
- …for the policies and procedures ensuring best and most appropriate treatment, care or services for members. UM Administration Coordinator 2 + Support the UM ... and arrange a safe facility discharge. + Work with UM Nurses, Pharmacy, Medical Directors and other...with the CarePlus Platform. + Proficient and/or experience with medical terminology and/or ICD-10 codes. + Member service… more
- Magellan Health Services (Boise, ID)
- …community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria. + Participates in ... solutions that directly influence quality of care. General Job Information Title Care Manager ( UM /UR) - Remote, Idaho Licensed Grade 24 Work Experience -… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- About The Role Brighton Health Plan Solutions provides Utilization Management services to its clients. Senior UM Coordinators facilitate utilization review by ... requests for preservice, prospective, and concurrent reviews. The Senior UM Coordinator reports to the Manager , Utilization...+ Bilingual preferred, but not required. + Strong customer service skills required. + History working in medical… more
- Elevance Health (FL)
- …management role is responsible for utilization management review for Behavior Analysis services . **How you will make an impact:** + Uses appropriate screening ... healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to...approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and there is licensed staff supervision. +… more
- LifePoint Health (Las Cruces, NM)
- …**Organization:** **Memorial Medical Center* **Title:** *Registered Nurse (RN) Case Manager - UM - PRN (Remote)* **Location:** *New Mexico-Las Cruces* ... you are not just what you can do. Memorial Medical Center is a 199-bed hospital offering a spectrum...a spectrum of care, including diagnostic, therapeutic, and rehabilitative services , both on an inpatient and outpatient basis. *Where… more
- The Cigna Group (Bloomfield, CT)
- …to assist with discharge planning, aftercare follow-up appointments, and integration of services with Medical and Pharmacy. + Engage with customers and ... a background in the insurance industry as a care manager in a behavioral healthcare role, or an individual...area of utilization management, or in direct provision of service as a mental health or chemical dependency counselor.… more
- ManpowerGroup (Columbia, SC)
- …support review determinations. + Identify and make referrals to appropriate staff (eg, Medical Director, Case Manager , Preventive Services , etc.). + ... + **Title:** Managed Care Coordinator UM II + **Location:** Initial on-site work required...service plans, eligibility, level of benefits, place of service , length of stay, and medical necessity.… more
- Healthfirst (NY)
- …**Duties and Responsibilities:** + Responsible for developing clinical criteria, medical policies for provider administered medications, review of monthly reports ... medicine, and trends in medicine. + Work with prescribing physicians and Medical Directors to discuss clinical rationale for review decisions Supervises, evaluates,… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …for a designated patient caseload. Collaborates with the attending LIP, Clinical Case Manager , nurse, and other members of the treatment team, ACCESS center staff ... concerns to the treatment team, Director of Utilization Management, and the Medical Director. + Review charts at identified review points and attend treatment… more
- Elevance Health (Seven Fields, PA)
- ** Manager II Behavioral Health Services ** **Location:** This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles ... of one of our Elevance Health PulsePoint locations. The ** Manager II Behavioral Health Services ** will be...will be responsible for Behavioral Health Utilization Management (BH UM ), or Behavioral Health Case Management (BH CM) or… more
- Magellan Health Services (Hodge, LA)
- … UM and CM meetings as needed. + Audits and reviews case manager , Health guide, UM staff, vendor, and provider documentation and telephone interactions ... services and quality of care including the development and coordination of in- service education programs for vendors, providers, UM staff, and case managers.… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Medical Management Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ... net required to achieve that purpose. Job Summary The Manager of Medical Management is responsible for...and activities requiring clinical licensure in the Utilization Management ( UM ) department. This position will work closely leaders to… more
- Houston Methodist (Baytown, TX)
- …and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and exceed service -level goals ... At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible...quality improvement processes related to admission, concurrent and retrospective UM and medical claims programs. Collaborates with… more
- University of Michigan (Ann Arbor, MI)
- …This 1.0 FTE position is dedicated to the management of University of Michigan ( UM ) Health specialty pharmacy clinical services with direct oversight of clinical ... services in the hematology/oncology, gastroenterology/hepatology/HIV, and rheumatology service lines. This position reports directly to the Pharmacy Assistant… more
- LA Care Health Plan (Los Angeles, CA)
- …to the needs of LA Care's culturally diverse membership. The position supports the UM Manager /Director. This role also assists UM Educator/ Manager ... required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations of the UM… more
- Omaha Children's Hospital (Omaha, NE)
- …8:00-4:00 as needed. No weekends or holidays** At Children's, the region's only full- service pediatric healthcare center, our people make us the very best for kids. ... and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly… more
- LA Care Health Plan (Los Angeles, CA)
- …Job Summary The Supervisor, Authorization Technician supports the Utilization Management ( UM ) Specialist by handling all administrative and technical functions of ... Authorization Technicians Leads, Authorization Technician and clerical staff in the UM department. Ensure Associate Supervisors are providing consistent and direct… more