- Fallon Health (Worcester, MA)
- …Registered Nurse in a clinical setting required. * 2 years' experience as a Utilization Management / Prior Authorization nurse in a managed care payer ... on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests ( prior… more
- Humana (Columbus, OH)
- …interviewing, hiring, training, performance evaluation, coaching and up to termination. + Utilization management + Prior experience within discharge ... community and help us put health first** The Manager, Utilization Management Nursing utilizes clinical nursing skills...case management + Health Plan experience + Prior Medicare / Medicaid experience + Call center or… more
- Katmai (Usaf Academy, CO)
- …Bachelor of Science in Nursing (BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, ... licensed in Colorado, be able to practice using a nurse compact state license or have a license from...checks. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional… more
- University of Utah Health (South Salt Lake, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- US Tech Solutions (Chicago, IL)
- …an RN + Registered Nurse in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST HAVE ... and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1...Prior Authorization? + Do you have experience with Utilization Review? + Do you have an Active Registered… more
- Independent Health (Buffalo, NY)
- …**Essential Accountabilities** Provide High Quality, Professional Utilization Management Services: (Medical necessity review for prior authorization, ... payment review.) + Prompt, courteous, professional and error free in performing utilization management functions. + Available to answer inbound phone calls… more
- CDPHP (Albany, NY)
- …required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is ... you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for...transportation, DME requests and inpatient readmissions. In collaboration with management , the UR nurse identifies potentially high-cost… more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** Full-time, Day shift + **Facility:** St. Agnes Hospital + **Location:** Baltimore, MD + ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
- US Tech Solutions (May, OK)
- …experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT platforms/systems ... and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization. Education: . Active and unrestricted RN licensure… more
- CVS Health (Baton Rouge, LA)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedule may include weekends, ... to work in a fast paced environment **Preferred Qualifications** - Previous prior authorization experience - Bachelor of Science in Nursing (BSN) **Education**… more
- Sanford Health (SD)
- …- $28.00 **Department Details** Opportunity to work remote. **Job Summary** Monitors the utilization of resources, risk management and quality of care for ... multiple administrative duties including accurate record keeping and electronic data management when needed. Ability to work with growth and development needs… more
- Centene Corporation (Cheyenne, WY)
- …licensure as outlined by the applicable state required. Knowledge of BH utilization management principles preferred. Prior supervisory experience preferred ... care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours a week. + **Hospital:** Ascension Saint Thomas + **Location:** ... TN market. We're looking for an experienced Director of Utilization Management to join our team! In...management programs. + Oversee implementation and maintenance of prior authorization codes for all clients. **Requirements** Licensure /… more
- Hackensack Meridian Health (North Bergen, 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 ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to...regulatory guidelines (ie., Important Message 4 to 48 hours prior to discharge, appeal and HINN notices). + Maintains… more
- VNS Health (Manhattan, NY)
- …and updates through on-going training, coaching and educational materials. + For Utilization Management Only: + Issues Determinations, Notices of Action, and ... treatment, level of care and lengths of stay. Performs prior authorization and concurrent reviews to ensure extended treatment...by state or federal regulations are saved in the Utilization Management System. + Reviews, evaluates and… more
- Sanford Health (Sioux Falls, SD)
- … and potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality of care for patients in ... Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to… more
- Prime Healthcare (Inglewood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/200257/director-of-case- management utilization - management ... leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and … more
- Elevance Health (Louisville, KY)
- **Title: Utilization Management Representative II** **Location:** This position will work a remote model. Ideal candidates will live within 50 miles of one of ... our PulsePoint locations. The ** Utilization Management Representative II** will be responsible for managing incoming calls, including triage, opening of cases… more
- Elevance Health (Richmond, VA)
- **Title: Utilization Management Representative I** **Location:** This position will work a remote model. Ideal candidates will live within 50 miles of one of our ... PulsePoint locations. The ** Utilization Management Representative I** will be responsible...will be responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:**… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... particular department/unit. This includes, but is not limited to, the management of: + Program-specific applications, quality improvement, staff education, medical… more