- Evolent Health (Columbus, OH)
- …resolutions, driving results, and collaborating with others. **Collaboration Opportunities** : The Lead Nurse of Utilization Management is responsible for ... UM Manager in supervising the operational productivity of the Utilization Management nurses by implementing and maintaining...flow of information through the UM department. The UM Lead , in collaboration with the UM Manager and Director,… more
- Dignity Health (Bakersfield, CA)
- …Arizona, with a clear and current CA RN license.** **Position Summary:** The Director of Utilization Management is the senior lead over the utilization ... of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population...UM Director is also responsible for the oversight of utilization management auditing, both internal and external,… more
- Bristol Myers Squibb (Tampa, FL)
- …metrics to measure the cost-of-service delivery and ongoing administration and vendor utilization . + Lead vendor management activities, contract renewals, ... managing comprehensive benefits programs with a customer-centric and successful vendor management approach. This position requires a blend of strategic planning,… 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...UR and/or outpatient referral authorizations. **Great opportunity for a Lead Care Coordinator to work in an organization that… more
- Point32Health (Canton, MA)
- …at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director, Utilization Management is responsible for directing, leading, and ... modifying the business processes and operations for all levels of utilization management review (ie, Precertification and Intake Services, Inpatient &… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director of Utilization Management leads and manages all utilization management (UM) functions for physical ... regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting strategic direction,… more
- The Cigna Group (Franklin, TN)
- The Chief Medical Officer (CMO) Utilization Management will develop and manage efforts to improve and maintain cost and utilization trends. Responsible for ... departments of insurance, and similar accreditors/regulators for the performance of all utilization management (UM) programs across the enterprise. The CMO is… more
- Trinity Health (Silver Spring, MD)
- …closely related area. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + Knowledge of pertinent regulatory, ... **Employment Type:** Full time **Shift:** **Description:** The Manager-Care Management & Utilization Review, under the supervision and in collaboration with the… more
- Huron Consulting Group (Chicago, IL)
- …standards. + Participate in quality assurance activities to improve utilization management processes and patient care outcomes. + Lead UM Denials Team ... you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring...daily Staff Huddles for operations and priorities review. + Lead Patient Care Management Escalation Huddles to… more
- Trinity Health (Silver Spring, MD)
- …acute healthcare setting required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At least 5-7 years ... - 4:30pm + Reporting to the Director of Care Management + The RN Manager is responsible and accountable...RN Case Managers for in inpatient care coordination and utilization review. Oversees interactions of staff with outside activities… more
- Trinity Health (Pontiac, MI)
- …customers and community groups. **D.** **Experience** Three years recent acute care utilization management experience. Knowledge of regulations relative to ... RN licensure within the State of Michigan. Certified Professional in Utilization Review/ Management preferred. **C** **Special Skill / Aptitudes** Understanding… more
- SSM Health (St. Louis, MO)
- …the department leaders and staff in managing fiscal resources for the utilization management program. Maintains and leverages ongoing business relationships with ... in accreditation process with surveying and accreditation bodies as the expert on utilization management (UM) policies and practices. + Collaborates with other… 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 ... Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead provider...a dyad partnership with the Director of Clinical Resource Management . This position is full-time, 1.0 FTE, and will… more
- LifeCenter Northwest (Bellevue, WA)
- … Manager (OUM) is responsible for the strategic direction and daily operational management of the Organ Utilization Coordinator Team (OUCT). This leadership role ... + Lead and oversee day-to-day operations of the organ utilization function, ensuring the team executes allocation and logistical activities. + Develop,… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team of UM ... (BSN) degree required + Five or more years of utilization management required + Four or more...methods and systems to improve efficiency + Ability to lead and facilitate cross-functional workgroups and other meetings +… more
- Elevance Health (Tampa, FL)
- RN Utilization Management Nurse Sr. (Medicaid-InPatient) JR130851 **Location:** Must be within 50 miles / 1 hour commute of Tampa or Miami, FL offices. This is ... Holidays** per year and **occasional** weekends. The **Nurse Medical Management Sr** serves as T **eam Lead **...Requires minimum of 5 years acute care clinical experience, utilization management or managed care experience; or… more
- Dignity Health (Bakersfield, CA)
- …practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment, ... of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population...Minimum of 10 years+ of clinical experience in a Utilization Management setting preferred - Board Certified… more
- Trinity Health (Fresno, CA)
- …populations across the acute care continuum. This includes discharge planning, utilization management , care coordination collaboration, and support for resource ... with an interdisciplinary team to improve patient care through the effective utilization of the facility's resources. 1. Current licensure as a Registered Nurse… more
- Amazon (Seattle, WA)
- …to oversee data center electrical infrastructure optimization projects. You will lead cross-functional and technical teams identify sub-optimal utilization , ... job is for you! Key job responsibilities - Optimize utilization of electrical distribution systems across AWS data center...Qualifications - Bachelor's Degree AND 5+ years of project management experience OR 8+ years of project management… more
- Elevance Health (Tallahassee, FL)
- ** Utilization Management Representative II** **Location:** Must live within 50 miles of a Florida PulsePoint. The ** Utilization Management Representative ... eligibility information. + May act as liaison between Medical Management and internal departments. Responds to telephone and written...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more