- Cleveland Clinic (Vero Beach, FL)
- …Manager. May design and initiate special projects as supervised by the Team Manager. Utilization Management Specialist Join our team at Cleveland Clinic ... hospital stay or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review, providing clinical information… more
- ManpowerGroup (Durham, NC)
- Our client, the largest health care industry, is seeking a utilization management specialist to join their team. If you are detail-oriented, experienced in ... background, we encourage you to apply for this remote opportunity. **Job Title:** Utilization Management Specialist **Location: REMOTE** **Pay Range: $24/hr… more
- Motion Recruitment Partners (Durham, NC)
- Utilization Management Specialist Durham, NC **100% Remote** Contract $17/hr - $17/hr Our client, a nationally recognized and award-winning company in the ... health insurance vertical, has a contract opening for a Utilization Management Specialist . They have over 4 million customers and 5,000+ employees dedicated… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist , will analyze clinical information, contracts,… more
- UCLA Health (Los Angeles, CA)
- Description As the Utilization Management & Quality Review Specialist , you will be responsible for: + Managing service requests and potential quality issue ... cases, ensuring compliance with regulatory requirements for both utilization management and quality assurance processes + Ensuring that all cases are processed… more
- Spectrum Billing Solutions (Skokie, IL)
- …mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist | Revenue ... Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health Billing … more
- Moss Adams LLP (San Diego, CA)
- …staff, human resources, and internal accounting to promote people development and maximize utilization . The Resource Management Specialist will work to ... **Resource Management Specialist ** **Description** Moss Adams brings... team to implement our people strategy, monitor staff utilization , coordinate staff schedules, and deploying resources. This role… more
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... in the area of service decisions and organizational determinations.The Manager, Utilization Management reports to the Director of Clinical Effectiveness.… more
- ManpowerGroup (Columbia, SC)
- …States and in the state of hire. **Job Description:** As a Medical Claims Reviewer/ Utilization Management Specialist , you will be responsible for conducting ... medical reviews using established criteria sets, performing utilization management of professional, inpatient or outpatient, facility benefits or services, and… more
- LA Care Health Plan (Los Angeles, CA)
- …achieve that purpose. Job Summary The Supervisor, Authorization Technician supports the Utilization Management (UM) Specialist by handling all administrative ... Supervisor, Authorization Technician Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time… more
- ManpowerGroup (Columbia, SC)
- …join one of our Fortune 500 clients. **Job Summary** The Medical Review and Utilization Management Specialist is responsible for performing medical reviews ... using established criteria and conducting utilization management of professional, inpatient, outpatient, or...completed timely and in accordance with contractor standards. The specialist will educate members, families, and staff on coverage… more
- Hackensack Meridian Health (Hackensack, NJ)
- …a. Provides direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight for accurate patient ... **Overview** The Senior Utilization Review Specialist collaborates with the...vs. Inpatient c. Liaison to the Medical Staff supporting Utilization Management Committee processes d. Hospital Based… more
- BayCare Health System (Clearwater, FL)
- …responsibility and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and ... compassionate team. **The Utilization Review Specialist Senior responsibilities include:** +...+ Required RN (Registered Nurse) + Preferred ACM (Case Management ) + Preferred CCM (Case Manager) **Education:** + Required… more
- Integra Partners (Troy, MI)
- …to join our Operations Training & Development team as an Operations UM Training Specialist , specializing in Utilization Management (UM) processes. The ideal ... industry standards, regulatory requirements, and best practices in clinical documentation and utilization management and update training documents as required +… more
- CaroMont Health (Gastonia, NC)
- …to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments, ... liaison to managed care organizations. Communicates with attending physicians regarding utilization issues. Collaborates with discharge planning specialist and… more
- Munson Healthcare (Traverse City, MI)
- …of resources. + Assists in developing and revising policies to support utilization management activities, including criteria and guidelines for appropriate use ... colleagues and hospital associates at information meetings. + May represent Utilization Management on various committees, professional organizations, physician… more
- Veterans Affairs, Veterans Health Administration (San Juan, PR)
- Summary The Supervisory Acquisition Utilization Specialist renders expert contract pre-award and post award expertise to all Administrative and Clinical Service ... not a virtual position. Position Description/PD#: Supervisory Acquisition & Utilization Specialist /PD99867A Relocation/Recruitment Incentives: Not Authorized Critical… more
- Veterans Affairs, Veterans Health Administration (North Charleston, SC)
- Summary As the Acquisition Utilization Specialist you will serve as the medical center liaison and advisor on contract related services focusing on critical ... is not a virtual position. Position Description/PD#: Acquisition & Utilization Specialist /PD07899A Relocation/Recruitment Incentives: Not Required Requirements… more