- Magellan Health Services (Boise, ID)
- …solutions that directly influence quality of care. General Job Information Title Care Manager ( UM /UR) - Remote, Idaho Licensed Grade 24 Work Experience - ... + Maintains an active work load in accordance with National Care Manager performance standards. + Works with community agencies as appropriate. Proposes alternative… more
- Elevance Health (Norfolk, VA)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Molina Healthcare (Columbus, OH)
- …levels of leadership across the organization. + Experience with CM and UM **PREFERRED EDUCATION** : Graduate Degree or equivalent combination of education and ... experience. **PREFERRED EXPERIENCE** : * 5-7 years of Program and/or Project management experience.* Managed Care experience. * Experience working in a cross functional highly matrixed organization. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : * PMP,… more
- AmeriHealth Caritas (Newtown Square, PA)
- …therapeutic committee and work closely with the Directors of Pharmacy, pharmacy benefits manager (PBM), and the State's PBM team. + Prepare reports and conduct ... analysis of operations / services as required by departmental, corporate, regulatory, and State requirements. Work collaboratively with Information Services Department on identifying required data for reporting. + Assist in preparation, coordination, and… more
- Cleveland Clinic (Cleveland, OH)
- …Physician Adviser interaction and special projects which are coordinated and directed by the UM Team Manager . **A caregiver in this position works 8:00AM - ... Utilization Management ( UM ) RN Reviewer Join the Cleveland Clinic team,...and initiate special projects as supervised by the Team Manager . Minimum qualifications for the ideal future caregiver include:… more
- CVS Health (Hartford, CT)
- …make health care more personal, convenient and affordable. **Position Summary** The UM Automation team manages the implementation of strategic initiatives for the ... UM Clinical Services organization. These initiatives leverage technical capabilities...artificial intelligence, rules engines, and predictive analytics to automate UM transactions, enhance workflow efficiencies, and improve experiences for… more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- …care and the appropriateness and timeliness of services provided. Recommendations from the UM Manager on the cost effectiveness and efficiency of programs have ... Summary The Utilization Management ( UM ) Nurse Manager (NM) is a registered professional nurse responsible for the assessment, planning, provision and evaluation… more
- UNC Health Care (Hendersonville, NC)
- …health and well-being of the unique communities we serve. Summary: The Utilization Manager ( UM ) assesses new admissions, continued stay and discharge review ... needs are met and care delivery is coordinated. The UM completes utilization reviews in accordance with federal regulations...patient data and treatments. Communicates daily with the Care Manager to manage level of care transitions & appropriate… more
- Independent Health (Buffalo, NY)
- …perks, benefits and commitment to diversity and inclusion. **Overview** The Program Manager -Utilization Management ( UM ) will be accountable for the management, ... trend and cost containment activities, and services on automated UM review. The Program Manager will ensure...services on automated UM review. The Program Manager will ensure accurate implementation, system configuration and appropriate… 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 ... and well-being of the unique communities we serve. **Seeking full-time on-site RN Care Manager to work a variable schedule of 4- 10-hour days (Friday-Monday) or 3-… more
- McLaren Health Care (Detroit, MI)
- **Position Summary:** Responsible for providing assistance to the Utilization Manager ( UM ) RN in the coordination of patient admission and continued stay ... **Essential Functions and Responsibilities as Assigned:** 1. Collaborates with the UM RN to determine the appropriate hospital setting (inpatient vs. observation)… more
- LA Care Health Plan (Los Angeles, CA)
- …interaction to develop and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, ... cost cases and reports are maintained and referred to the Physician Advisor/ UM Director. Document in platform/system of record. Utilize designated software system to… more
- Dignity Health (Northridge, CA)
- …insurance setting is required. + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred. + Knowledge of managed care ... centers. Visit dignityhealth.org/northridgehospital (https://www.dignityhealth.org/socal/locations/northridgehospital) for more information. RN Case Manager (Care Coordinator) Case Manager Northridge Hospital… more
- University of Michigan (Ann Arbor, MI)
- …student enrichment and community building + Triage matters to the Student Services Manager , Undergraduate Chair or UM campus resources as appropriate + ... AI tools + Facilitate 1:1 orientation meetings for both UM cross campus and external transfer students. + Facilitate...Career Planning and Alumni Engagement Coordinator, the Student Services Manager , as well as the BME Student Services Assistant.… more
- Humana (Columbus, OH)
- …part of our caring community and help us put health first** The UM Administration Coordinator 2 provides non-clinical support for the policies and procedures ... and most appropriate treatment, care or services for members. UM Administration Coordinator 2 + Primarily receive calls from...in special projects as assigned by your Supervisor or Manager . **Use your skills to make an impact** **Required… more
- Apex Health Solutions (Houston, TX)
- Summary: The UM Reviewer serves as a contact and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM ... or issues arise. To support care management initiatives, the UM Reviewer should also identify enrollees in need of...policy. Performs other related duties as requested by Supervisor, Manager , or Director. Achieves an in-depth knowledge of client… more
- Fallon Health (Worcester, MA)
- **Overview** **The UM Inpatient Service Coordinator is a telphonic role working with hospital offices regarding inpatient or hospital stays prior authorizations for ... (TruCare and/or QNXT). Responsible for incoming calls for the UM department addressing and/or referring customer (provider/member) calls/inquiries, provide direction… 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 ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- The Cigna Group (Bloomfield, CT)
- …Knowledge of managed care preferred. + Works independently, receiving direction from manager or team leader for new or unprecedented situations. + Manages own ... to assure timely discharge/transfer to an alternate level of care. + Consults with manager and medical director to resolve any issues related to delay of services or… more
- Dignity Health (Northridge, CA)
- …years of nursing experience. + Certified Case Manager (CCM) Accredited Case Manager (ACM-RN) or UM Certification preferred + Knowledge of managed care and ... payer environment preferred. This position is represented by SEIU-121 and is covered by the terms and conditions of the applicable collective bargaining agreement. **Pay Range** $53.41 - $76.02 /hour We are an equal opportunity/affirmative action employer. more
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