- Chestnut Health Systems (Carlock, IL)
- …(Billing) position is based in Normal, IL. Responsibilities Support agency management in billing and collections of accounts receivable. Review and submit ... aging report; follow up on unpaid claim balances. Communicate with Utilization Review Coordinator regarding authorizations and appeals, documenting all communication… more
- Commonwealth Care Alliance (Boston, MA)
- … Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management … more
- Centene Corporation (Madison, WI)
- …Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages prior authorization, concurrent review, and retrospective clinical review team and ensures… more
- ERP International (Nellis AFB, NV)
- …No Call, No Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific Quality ... disciplines to include discharge planning and referrals for case management . * Utilization management duties incorporate discharge planning to ensure that… more
- VNS Health (Manhattan, NY)
- OverviewManages the utilization management team to ensure that standards for service delivery and team/staff performance levels are met or exceeded. This ... quality issues or complaints, and/or approvals requiring next level authorization (eg, utilization management , high cost services, out of network services,… more
- Sharp HealthCare (San Diego, CA)
- …the episode of care and supports other members of the System Centralized Utilization Management team to ensure final status reconciliation. This position ensures ... Qualifications** + Bachelor's Degree in a health related field. + 3 Years Utilization Management or case management within a hospital or payer setting. +… more
- Sharp HealthCare (San Diego, CA)
- …Qualifications** + Bachelor's Degree in Healthcare or a related field + 3 Years Utilization Management or case management within a hospital or payer ... Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American Case… more
- CVS Health (Columbus, OH)
- …and affordable. **Primary Job Duties & Responsibilities** + Drives effective utilization management practices by ensuring appropriate and cost-effective ... use of healthcare resources. + Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of healthcare… more
- Sharp HealthCare (San Diego, CA)
- …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... as Allscripts.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
- CVS Health (Austin, TX)
- …to make health care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is fully remote and ... dedicated team supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document… more
- CVS Health (Phoenix, AZ)
- …to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the ... the need of the department.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... net 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… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours week. + **Hospital:** Ascension Saint Thomas + **Location:** ... throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role, you'll lead clinical… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Hackensack Meridian Health (Holmdel, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Crouse Hospital (Syracuse, NY)
- Utilization Management Registered Nurse has well-developed knowledge and is proficient with standard Utilization Review processes. The Utilization ... based on their appropriate admission status. This individual will support the Utilization Management process by maintaining effective and efficient processes for… more
- CVS Health (Tallahassee, FL)
- …to make health care more personal, convenient and affordable. **Position Summary** Utilization management is a 24/7 operation. Work schedules may include ... weekends and holidays and evening rotations. This is a full-time remote Utilization Management Nurse Consultant opportunity. As a Utilization Management … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …medical necessity criteria and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning + Understand and ... to obtain and/or share information relating to benefits and the BCBSMA utilization management process + Collaborate with members/families, providers, medical… more
- Penn State Health (Hershey, PA)
- …**SUMMARY OF POSITION:** Position is responsible to thoroughly understand all Utilization Management regulatory requirements for both CMS and DOH, ... the processes. The incumbent is responsible for identifying and communicating utilization management concerns to physician and administrative leadership to… more
- CVS Health (Columbus, OH)
- …and work schedules may include weekends, holidays, and evening hours_ As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... + 1+ years of clinical experience in acute or post-acute setting + Utilization management is a 24/7 operation. Work schedules will include a minimum of 6… more
