- Integra Partners (Troy, MI)
- …educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes. The ... a strong nursing background combined with expertise in clinical documentation, medical necessity determination, regulatory compliance, and will be responsible for… more
- Magellan Health Services (Boise, ID)
- …community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria. + Participates in ... solutions that directly influence quality of care. General Job Information Title Care Manager ( UM /UR) - Remote, Idaho Licensed Grade 24 Work Experience -… more
- Humana (Tallahassee, FL)
- …for the policies and procedures ensuring best and most appropriate treatment, care or services for members. UM Administration Coordinator 2 + Support the UM ... and arrange a safe facility discharge. + Work with UM Nurses, Pharmacy, Medical Directors and other...with the CarePlus Platform. + Proficient and/or experience with medical terminology and/or ICD-10 codes. + Member services… more
- Elevance Health (Norfolk, VA)
- …management role is responsible for utilization management review for Behavior Analysis services . **How you will make an impact:** + Uses appropriate screening ... healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to...approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and there is licensed staff supervision. +… more
- Apex Health Solutions (Houston, TX)
- …person to Health Solutions' members for the utilization review (UR) of healthcare services . The UM Reviewer will be responsible for complying with utilization ... Summary: The UM Reviewer serves as a contact and resource...are received directly from providers or enrollees. Conducts timely medical necessity reviews of all covered services … more
- Sutter Health (Sacramento, CA)
- …leadership, Nurse Executives and Directors, Risk Management & Ethics staff, Ancillary Services , Revenue Cycle and Finance Department leaders, Medical Directors, ... measurements for the Utilization review team and exhibits a customer service philosophy. Designs, implements and directs utilization review processes for effective… more
- Fallon Health (Worcester, MA)
- …assist in processing authorization information in order to facilitate the member's medical services or the providers' claims. Interprets and triages information ... **Overview** **The UM Inpatient Service Coordinator is a...for first level call resolution oversight. Interact with department's Manager to identify areas that need improvement or change… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services /Management staff work to ensure that Molina members have access to all medically necessary prescription ... drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review, patient… more
- Elevance Health (Las Vegas, NV)
- …/ 1 hour commute of an Elevance Health Office The Wound Care UM RN is responsible for performing pre-certification certification and/or authorization activities for ... Home Health Services for members with wound care needs included as...continued care. + Performs reviews telephonically using the members medical records discussion with the members physician and/or discussion… more
- Elevance Health (NY)
- …Will Make an Impact** Primary duties may includes, but are not limited: + Confirms medical services are appropriate based on assigned benefit plan, medical ... ** Medical Management Clinician Associate (RN)** **Location:** Elevance Health...Multi-state licensure is required if this individual is providing services in multiple states. **Preferred Skills, Capabilities and Experiences**… more
- Ventura County (Ventura, CA)
- Manager - Patient Services - Ventura County Health...per year, increasing to 288 hours after 5 years of service , to 328 hours after 10 years of service ... Care Plan Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4781106) Apply Manager - Patient Services - Ventura County..., and to 368 hours after 15 years of service or other public service . *Credit for… more
- Independent Health (Buffalo, NY)
- …services on traditional UM pre- service , concurrent and retrospective review, services not currently on medical review as outlined by trend and cost ... Medical Management program and seeking approval from Medical Directors and Heathcare Service leadership to...containment activities, and services on automated UM review. The Program Manager will ensure… more
- Houston Methodist (Houston, TX)
- …and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and exceed service -level goals ... assurance and quality improvement processes related to admission, concurrent and retrospective UM and medical claims programs. Collaborates with medical … more
- Veralto (Sterling, VA)
- OTT HydroMet sucht zum nachst moglichen Zeitpunkt einen **Global Tech Support Manager Hydro & Met (m/w/d)** . Diese Stelle kann an einem unserer Standorte in ... von ca. 20 % erwartet. Der Global Tech Support Manager Hydro & Met ist eine herausfordernde Fuhrungsposition mit...zu managen und zu betreuen. Sie leiten diese an, um die jahrlichen Serviceziele zu erreichen, sich an den… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Medical Management Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ... net required to achieve that purpose. Job Summary The Manager of Medical Management is responsible for...and activities requiring clinical licensure in the Utilization Management ( UM ) department. This position will work closely leaders to… more
- University of Miami (Miami, FL)
- …such as UChart, Cerner, PACS for non-enrolled research fellows and non- UM medical students + Assist Senior Manager of Business Operations with research ... of Miami/UHealth Department of Neurological Surgery is currently seeking a full time Sr. Manager , Research Support to work in Miami, FL. The Senior Manager ,… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred: Experience in Medi-Cal managed care. 1 year of experience in UM /Prior Authorization. Skills Required: Demonstrated proficiency in Medical Terminology ... Job Summary The Authorization Technician II supports the Utilization Management ( UM ) Specialist by handling all administrative and technical functions of the… more
- Omaha Children's Hospital (Omaha, NE)
- …8:00-4:00 as needed. No weekends or holidays** At Children's, the region's only full- service pediatric healthcare center, our people make us the very best for kids. ... and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly… more
- UNC Health Care (Raleigh, NC)
- …(EDD). Complete follow-up from CAPP as appropriate. As necessary meet with the Utilization Manager ( UM ) and SW after the meeting to discuss updates and action ... team on an ongoing basis. Identify required authorization for post-discharge services and refer to the appropriate post-discharge service provider.… more
- Elevance Health (Baton Rouge, LA)
- **Louisiana Crisis Manager II Behavioral Health Services ** **Location: Baton Rouge, Louisiana** This position will work a hybrid model (remote and office). Ideal ... of one of our PulsePoint locations. The **LA Crisis Manager II Behavioral Health Services ** is responsible...make an impact:** + Serves as a resource for medical management programs. Identifies and recommends revisions to policies/procedures.… more
Related Job Searches:
Manager,
Manager Medical Services,
Medical,
Medical Manager,
Medical Services,
Services