- AmerisourceBergen Drug Corporation (Conshohocken, PA)
- …serialization phase in, and establishing a product serialization label review processes.Primary Duties and Responsibilities:Manage the overall Cencora inbound DSCSA ... resolution with 400+ pharmaceutical manufacturing partners, enterprise IT, category management , regulatory assurance, and other various cross-functional teamsEstablish and… more
- Point32Health (Canton, MA)
- …leading, and modifying the business processes and operations for all levels of utilization management review (ie, Precertification and Intake Services, ... who we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director , Utilization Management is responsible for directing,… 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) ... processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops...medical staff on issues related to utilization management . 8. Implements utilization review … more
- CareFirst (Baltimore, MD)
- …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred Qualifications:** +… more
- Dignity Health (Bakersfield, CA)
- …Nevada or Arizona, with a clear and current CA RN license.** **Position Summary:** The Director of Utilization Management is the senior lead over the ... day-to-day operations of the UM nursing teams including preservice utilization review , concurrent inpatient review ,...Director is also responsible for the oversight of utilization management auditing, both internal and external,… more
- Trinity Health (Boise, ID)
- …of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance ... MDDUE will work in a dyad partnership with the Director of Clinical Resource Management . This position...patients not meeting inpatient criteria. C. Participates in local Utilization Review Committee and be a member… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according to… more
- Dignity Health (Bakersfield, CA)
- …practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment, ... decision making in the areas of: prior authorization, concurrent review of hospitalized patients, discharge planning management ....Minimum of 10 years+ of clinical experience in a Utilization Management setting preferred - Board Certified… more
- Fallon Health (Worcester, MA)
- …MA (or licensable). Board certified in medical or surgical specialty. **Experience:** Utilization management ; network management ; medical policy and ... inpatient case management rounds + Outpatient case management rounds + Provider appeals review +... + Pharmacy issues and referral requests + Medical director on-call coverage + Support the benefits and technology… more
- Trinity Health (Silver Spring, MD)
- …the activities of RN Case Managers for in inpatient care coordination and utilization review . Oversees interactions of staff with outside activities and agencies ... required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At...in an acute healthcare setting. + Designation Changes and Utilization Review + Knowledge of pertinent regulatory,… more
- UTMB Health (Galveston, TX)
- Utilization Review Case Mgr. - Galv....inappropriate resource utilization to Director /Assistant Director of Utilization Management . + ... the use of medical services, procedures, and facilities. Supports the UTMB Utilization Management Program utilizing clinical knowledge, expertise, and criteria… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …treatment team, Director of Utilization Management , and the Medical Director . + Review charts at identified review points and attend treatment ... of resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of care and promoting… more
- Billings Clinic (Billings, MT)
- …Starting Wage DOE: $35.34 - 44.18 Under the direction of department leadership, the Utilization Review / Management RN. This position is to conduct initial, ... prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic (Billings Clinic… 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 ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… 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 patients.* Applies MCG criteria to… more
- Independent Health (Buffalo, NY)
- …Collaborative and Accountable. **Essential Accountabilities** + Provide high quality, professional utilization management services: (medical necessity review ... benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse performs clinical reviews to....) + Prompt, courteous, and error free in performing utilization management functions. + Available to answer… more
- Trinity Health (Maywood, IL)
- …at the Westmont office Join our small but mighty team to guide and manage Utilization Review and Management for the Loyola Physician Partners LPP) Health ... Director /Manager oversees the daily caseloads of the UR/UM teams. This includes utilization review of inpatient medical and behavioral health services to… more
- Hartford HealthCare (Torrington, CT)
- …Inpatient Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the IP ... Psychiatry Patient Care Team to assure Utilization Review activities on a 17 bed...that may include: individual, group, & family therapy; case management , interdisciplinary collaboration for care transition needs, crisis intervention/safety… 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 Range: $31.28 - $51.61 per hour * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria… more
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