- Point32Health (Canton, MA)
- …we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director , Utilization Management is responsible for directing, ... with Point32Health business rules; oversight of all aspects of outpatient services utilization management ; and...leadership. The Director oversees and leads medical management activities related to precertification utilization … more
- CareFirst (Baltimore, MD)
- …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... utilization management team and is responsible for the design, assessment,...distinct units: Commercial UM intake and call center, Commercial outpatient medical pre-authorization review, Commercial inpatient and outpatient… more
- Catholic Health Initiatives (Lexington, KY)
- …can happen both inside our hospitals and out in the community. **Responsibilities** The Utilization Management (UM) Director 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… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/172723/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
- Fallon Health (Worcester, MA)
- …MA (or licensable). Board certified in medical or surgical specialty. **Experience:** Utilization management ; network management ; medical policy and ... of purpose:** This position works with both inpatient and outpatient Care Management nurses to monitor appropriate...review + Pharmacy issues and referral requests + Medical director on-call coverage + Support the benefits and technology… more
- Health First (Viera, FL)
- …**Executive Management * **Organization:** **Holmes Regional Medical Center* **Title:** * Director - Outpatient Rehab and Fitness * **Location:** *Florida ... of outpatient rehabilitation and fitness services to our community. The Director of Outpatient Rehabilitation and Fitness advocates for performance and… more
- Horizon Services, Inc. (Hayward, CA)
- …of front-line support and milieu staff to ensure full census and efficient utilization management at assigned program(s). Engages in marketing, client retention, ... JOB TITLE: Associate Director of Outpatient & Prevention Program...Compassion, Respect, and Professionalism, to provide residential treatment, withdrawal management , and sobering programs to support the well-being of… more
- Banner Health (Tucson, AZ)
- …ratings of hospitals' performance in 20 procedures and conditions. As the **Associate Director Registered Nurse RN Outpatient ** , you will bring your leadership ... will have responsibility for all operations of our new outpatient department. You will have the opportunity to build...the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change… more
- Houston Methodist (Houston, TX)
- …Houston Methodist, the Director Nursing position is responsible for the 24/7 management of the assigned nursing units and departments in terms of the quality of ... of strategic and operational objectives of the Department of Nursing. The Director Nursing position provides strategic direction for nursing and business operations,… more
- Helio Health Inc. (Syracuse, NY)
- …+ Implements quality improvement strategies to include establishment of outcome standards and utilization management . + Responsible for clinical care and fiscal ... staff, program development and ongoing quality improvement strategies. The Service Director will oversee ourCertified Community Behavioral Health Clinic (CCBHC) . In… more
- Huron Consulting Group (Chicago, IL)
- …as the expert you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring the appropriate ... to facilitate optimal patient outcomes while managing healthcare costs. The Utilization Management Specialist ensures compliance with regulatory requirements and… more
- Elevance Health (Topeka, KS)
- …and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of education and experience, ... role.** The **Manager of Behavioral Health - Kansas - Utilization Management (BH UM)** will manage a...to ensure medical necessity and appropriateness of care for inpatient/ outpatient BH services; ensures appropriate utilization of… more
- Billings Clinic (Billings, MT)
- …leadership and Physician Advisor, per department process or procedure Insurance and Utilization Management Maintains working knowledge of CMS requirements and ... - 44.18 Under the direction of department leadership, the Utilization Review/ Management RN. This position is...of tasks. Priority 1: Reviews New Admissions, Observation and Outpatient Cases Prioritize reviews of all OBS and bedded… 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
- Katmai (Usaf Academy, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... background checks. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in… more
- Martin's Point Health Care (Portland, ME)
- …Nurse required; BSN preferred. + 3+ (total) years clinical nursing experience + Utilization management experience in a managed care or hospital environment ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a...outcomes for those enrollees with a need for inpatient/ outpatient authorizations. This position receives and reviews prior authorization… more
- Albany Medical Center (Albany, NY)
- …Management /Social Work Work Shift: Day (United States of America) Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. Salary: $65,062.40 - $107,348.80 * Completes Utilization Management and Quality Screening for assigned...in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures… more
- Trinity Health (Maywood, IL)
- …preauthorization requests utilizing defined criteria. Collects, analyzes and communicates relevant utilization management information to insurers and third party ... our small but mighty team to guide and manage Utilization Review and Management for the Loyola...desired as well as experience with inpatient UR and/or outpatient referral authorizations. **Great opportunity for a Lead Care… more
- BayCare Health System (Clearwater, FL)
- …+ Strong utilization of medical terminology and anatomy. + Assists Manager/ Director with mentoring/training of Coder I and Coder II team members and clinical ... + Required High School or equivalent + Preferred Associate's in Health Information Management **Experience** + Required 5 years of Outpatient Coding Equal… more
- Ventura County (Ventura, CA)
- …and communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more