- 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. (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
- Independent Health (Buffalo, NY)
- …Management is responsible for assisting the Medical Director in the oversight of Utilization Management ( UM ) programs and will support the development and ... efforts to develop strategic corporate direction / focus for UM programs. The AMD will support the SVP, Healthcare...(5) years of post-graduate clinical experience in health care management and utilization review required; quality assurance… more
- Humana (Columbus, OH)
- …Medicare Advantage without being involved in bid season. They will partner closely with Utilization Management ( UM ) leadership to develop analytics for this ... modeling financial impacts and making financial projections related to the UM program . + Evaluate and continually monitor the overall performance of the… 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
- Elevance Health (Durham, NC)
- …+ Licensure is a requirement for this position. + Previous experience in case management / utilization management with a broad range of experience with complex ... Capabilities and Experiences:** + Bilingual in English and Spanish. + **Previous utilization management experience highly desired.** + **Experience with taking… more
- Kepro (AR)
- …Clinical Director and Medical Director, the Team Supervisor oversees clinical staff performing Utilization Management ( UM ) and Reviews services for Medicaid ... the public sector. Acentra is looking for a Dental UM Supervisor (Remote within Arkansas) to join our growing...experience in a dental setting. + Supervisory experience. + Utilization Management /Clinical Review experience. + Strong clinical… 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
- ManpowerGroup (Columbia, SC)
- …criteria to service requests. The individual will also provide health management program interventions, utilizing clinical proficiency, claims knowledge, and ... + **Title:** Managed Care Coordinator UM II + **Location:** Initial on-site work required...medical necessity and contract benefits. + Collaborate with Care Management and other areas for timely care management… 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
- The Cigna Group (Bloomfield, CT)
- …worked in a mental health or chemical dependency treatment facility in the area of utilization management , or in direct provision of service as a mental health ... clinical rounds with Evernorth Medical Directors for input on utilization management , and attending all required trainings...for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These… 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
- 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
- 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
- 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
- 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
- Elevance Health (FL)
- …Utilization Management for Behavior Analysis Services)** Responsible for Behavioral Health Utilization Management (BH UM ). Serves as a mentor to lower ... of care initiatives. + May attend meetings to review UM and discusses facility issues. + Hires, trains, coaches,...Candidate will be responsible for the oversight of the utilization management team. + Responsible for a… more
- LA Care Health Plan (Los Angeles, CA)
- …and to support the safety net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II is primarily responsible ... vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management...+ Tuition Reimbursement + Retirement Plans + Medical, Dental and Vision + Wellness Program + Volunteer Time Off… more