- Community Based Care of Brevard, Inc. (Melbourne, FL)
- …Summary: The SOR Peer Support Specialist works in partnership with the SOR Specialist, Utilization Management ( UM ) Program Manager, and Behavioral Health ... Team to assist individuals and families who come to the attention of the child welfare system due to Opioid s ubstance use/misuse disorders and/or other co-occurring disorders. The SOR Peer Support Specialist offers the perspective of having lived experienced… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …transform healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral ... level of care setting for continued treatment. Employs the utilization management process to assist in setting...Participate in the development and refinement of the Case Management Program . + Participate in department and… more
- Horizon Services, Inc. (Hayward, CA)
- …Utilization Management + Gather, monitor, and manage collection of utilization management ( UM ) data for assigned program (s). Report UM data ... census goals are met and maintained for assigned program (s). Address and resolve UM data integrity and management issues as needed. + Implement, monitor, and… more
- Integra Partners (Troy, MI)
- …& Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes. The ideal candidate will have a ... industry standards, regulatory requirements, and best practices in clinical documentation and utilization management and update training documents as required +… more
- Kepro (AR)
- …other Dental Physician Reviewers on case consultations as needed. + Discuss complicated Utilization Management reviews or clinical scenarios with Utilization ... public sector. Acentra is looking for an Oral Surgeon ( UM Reviewer) to join our growing team. Job Summary:...organization and policy. + Complete all secondary-level Dental/Oral Surgeon Utilization Management reviews. + Develop and complete… more
- Kepro (AR)
- …is responsible for the management and oversight of Arkansas Utilization Management Contract activities within clinical, contractual, and budgetary ... provide day-to-day oversight to manage multiple areas of the UM program and oversee the implementation of...and manages direct reports relative to their responsibilities for utilization management review; including but not limited… more
- ManpowerGroup (Columbia, SC)
- …and established clinical criteria to service requests or provides health management program interventions. + Utilizes clinical proficiency, claims ... Education:** Bachelor's degree- Nursing Preferred Work Experience: 7 years-healthcare program management . Preferred Licenses and Certificates: Case Manager… more
- LifePoint Health (Las Cruces, NM)
- …utilizes hospital resources in the development of care, discharge planning and Utilization Review. * Utilization Management performs prospective, admissions, ... observation and concurrent review according to standard policies and procedure. * Utilization Management reviews and analyze processes designed to ensure… more
- Centers Plan for Healthy Living (Margate, FL)
- UM Coordinator 5297 W Copans Rd, Margate, FL...plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a ... the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists… more
- CVS Health (Hartford, CT)
- …and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with ... to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal...for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed… more
- Molina Healthcare (Seattle, WA)
- …Experience with the adult behavioral health system in Washington State and** ** Utilization Management experience is highly preferred.** **_Further details to be ... **This position is to support the Community Behavioral Health Supports Program in Washington State.** **Community Behavioral Health Support (CBHS) services is… more
- Commonwealth Care Alliance (Boston, MA)
- … UM program and leads and organizes the ongoing evaluation of the utilization management program against quality and utilization benchmarks and ... Utilization Management leads and manages all utilization management ( UM ) functions for... Management team in managing and continuously improving UM program design, policies, procedures, workflows, and… more
- The Cigna Group (Franklin, TN)
- …state departments of insurance, and similar accreditors/regulators for the performance of all utilization management ( UM ) programs across the enterprise. The ... The Chief Medical Officer (CMO) Utilization Management will develop and manage...UM programs, including matters concerning clinical policy, quality management (QM), program development, review of … more
- LA Care Health Plan (Los Angeles, CA)
- …the safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day ... Supervisor, Utilization Management RN Job Category: Clinical...department's performance measures outcomes and goals. Plans and oversees UM activities according to model of care, program… more
- Stanford Health Care (Palo Alto, CA)
- …assistance! **This is an onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse ( UM RN) will be responsible for ... the institution, navigating the complexities of patient care and resource utilization management , and education. Primary responsibilities include: 1.… more
- Point32Health (MA)
- …to improve outcomes of assigned services such as CM and UM ( Utilization Management ). The Clinical Program Manager works directly and regularly ... Medicare and State Medicaid agency/contract compliance and accreditation requirements for Care Management , Utilization Management , and / or Member Appeals… more
- Catholic Health Initiatives (Lexington, KY)
- …is responsible for the market(s) development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the ... CommonSpirit Health Care Coordination model. The Utilization Management department processes authorizations, inpatient admission and continued stay reviews,… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will...UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare, and… more
- LA Care Health Plan (Los Angeles, CA)
- … Management Clinical Quality Nurse Reviewer RN II, under the purview the Utilization Management ( UM ) Department Leadership Team, is responsible for ... Utilization Management Clinical Quality Nurse Reviewer...to submit to the department's Quality Assurance Team and UM Management . Duties Facilitates the development, review,… more
- AmeriHealth Caritas (Dublin, OH)
- … UM OH, and serves as SME for clinical components of the OH Medicaid Utilization Management Program . Works in close collaboration with all departments to ... Officer for the Ohio Market, this position is representing Utilization Management ( UM ) in state... Audit and Compliance/Internal audits, pertaining to the OH Utilization Management program . + Act… more