- UCLA Health (Los Angeles, CA)
- …culture. You can do all this and more at UCLA Health. In this role as a Utilization Review Supervisor within our utilization department you would be ... of healthcare services within NPH. This role entails overseeing a team of utilization review nurses, ensuring compliance with clinical regulatory standards, and… more
- Centene Corporation (Atlanta, GA)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... perspective on workplace flexibility. Position Purpose: Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team… more
- SSM Health (MO)
- …management of daily operations within assigned region(s) or ministries related to the Utilization Management (UM) Review area under the direction of managers. ... Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES + Responsible for daily Utilization Management (UM) operations, which includes referrals, medical … more
- BayCare Health System (Cotton Plant, AR)
- …responsibility and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and ... compassionate team. **The Utilization Review Specialist Senior responsibilities include:** +...to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation… more
- CareFirst (Baltimore, MD)
- …accreditation standards and federal/state regulations and general principles relating to utilization review . + Computer skills, including Microsoft Office ... **Resp & Qualifications** **PURPOSE:** Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of… more
- Hartford HealthCare (Torrington, CT)
- …*Job Summary* Under the Direction of the Inpatient Nurse Director & Social Work Supervisor , the Inpatient Psychiatric Utilization Review Social Worker will ... with the IP Psychiatry Patient Care Team to assure Utilization Review activities on a 17 bed...employees with an extensive benefits package consisting of: * * Medical and dental benefits* * *401(k) plan with employer… more
- The Cigna Group (Bloomfield, CT)
- …issues, implications and decisions. The Case Management Analyst reports to the Supervisor /Manager of Appeals and will coordinate and perform all appeal related ... appeals will include requests for decisions regarding denials of medical services as well as Part B drugs. The...accurately; e) prepare case files for submission to Independent Review Entity, which also include writing required case summary… more
- Banner Health (AZ)
- …offering remote and hybrid work settings. In the role of a Behavioral Health Utilization Care Manager, you will be tasked with assignments at various hospitals to ... authorize initial admissions and conduct concurrent reviews to assess medical necessity. Your work will involve collaboration with both...SUMMARY This position is the point person for all utilization activities for assigned members. As part of an… more
- Commonwealth Care Alliance (Boston, MA)
- …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a ... Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care… more
- Kepro (Minneapolis, MN)
- …Summary: The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract ... partner for health solutions in the public sector. Acentra is looking for a Utilization Management - Mental Health Clinical Reviewer to join our growing team. This… more
- CVS Health (New Albany, OH)
- …Following training, position is remote with occasional in office requirement.** Utilization Review - Precertification Nurse is responsible for telephonically ... and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. Services… more
- Kepro (Chicago, IL)
- …Supervising and managing the day-to-day activities of the assigned case management and utilization review teams. . Mentoring, coaching, and training team members ... in the public sector. Acentra seeks a Clinical Operations Supervisor - RN (Remote US) to join our growing...Supervises, mentors, coaches, trains, and develops the: o Case review and utilization review teams… more
- WellSpan Health (York, PA)
- …with the CM leadership team in developing and maintaining CM policy including, Utilization Review , Social Services and Clinical Case Management. + Identifies ... Supervisor - Case Management Location: WellSpan Health, York,...initial reviews to ensure medial appropriateness of setting, concurrent review to ensure medical necessity for continued… more
- Cedars-Sinai (Tarzana, CA)
- …Los Angeles and beyond. **Req ID** : 3195 **Working Title** : RN Oncology Supervisor - Medical Oncology (CS Ventana Oncology Medical ) **Department** : ... **Job Description** The Supervisor , Clinical Operations Oncology RN is responsible for...arises. Duties and Responsibilities: + Assists in the development, review , and revision of standard operating policies and procedures… more
- UPMC (Harrisburg, PA)
- …AMA FREIDA). + Coordinate and maintain documentation pertaining to the UPMC Medical Education Annual Program Oversight Review (APOR) and anticipated required ... ensuring that the training program(s) are in full compliance with UPMC, UPMC Medical Education (ME), and Accrediting Body (ACMGE, AHSP, CODA, or CPME) policies and… more
- Rush University Medical Center (Chicago, IL)
- **Job Description** **Location:** Chicago, IL **Hospital:** RUSH University Medical Center **Department:** Kidney Transplantation **Work Type:** Full Time (Total FTE ... 12 Hr (7:30:00 AM - 7:30:00 PM) **Summary:** The Supervisor , Organ Placement RN is a registered nurse who...after January 1, 2014. All transfers to Rush University Medical Center or Rush University Medical Group… more
- University of Rochester (Rochester, NY)
- …PURPOSE: Under close direction of the section Technical Manager and/or Laboratory Medical Director, and under general direction of the Laboratory Assistant Director ... of Operations, the Laboratory Supervisor is responsible for overseeing the efficient operation of...LEAN practice and timely solutions. When appropriate, oversees final review of laboratory reports prior to release to the… more
- Louisiana Department of State Civil Service (Jackson, LA)
- …of subordinate nurses engaged in quality assurance, infection control, and utilization review activities. Receives physicians' instructions regarding patient ... REGISTERED NURSE SUPERVISOR A Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4667782) Apply REGISTERED NURSE...for this vacancy as well as future job opportunities. REVIEW YOUR APPLICATION TO MAKE SURE IT IS CURRENT.… more
- City and County of San Francisco (San Francisco, CA)
- …customers regarding electronic system development, implementation, issues, and recommendations and utilization of best practices; + Work with the EHR implementation ... requirements; + Evaluate workflows and recommend re-engineering of processes around utilization of computerized applications, including the new EHR to improve the… more
- Louisiana Department of State Civil Service (Monroe, LA)
- …of subordinate nurses engaged in quality assurance, infection control, and utilization review activities. Receives physicians' instructions regarding patient ... Registered Nurse Supervisor A Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4672958) Apply Registered Nurse Supervisor A Salary… more
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