- Alameda Health System (Oakland, CA)
- …plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic ... adapting to ad hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care. DUTIES & ESSENTIAL JOB… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the CMHS. ... and the TRICARE Operations Manual (TOM) access to care standards for appropriate utilization of services. Perform utilization management /review for medical… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …an experienced **MD** to join our team as an **Assistant Medical Director ( Utilization Management - Oncology)** . The AMD will leverage their specialization ... guidelines, and member contracts. In addition, they will support clinical programs (disease and case management ), as...in each case. + Consult with nursing and other clinical staff to assess and explore care… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …the UM Operations Trainer's primary job function is to support Utilization Management operations by training non- clinical staff on how to successfully ... perform any non- clinical tasks. This includes, but is not limited to, initial authorization processing (data entry, eligibility verification, benefits verification, and requesting required supporting documents from submitting provider offices), answering… more
- Tufts Medicine Care at Home (Haverhill, MA)
- …oversees one of the TM CAH Hospice teams. Assumes a leadership role with clinical staff to ensure that best practices are followed. Works cooperatively with ... to achieve desired outcomes promoting palliative care and hospice philosophy, holding staff accountable to current clinical standards of palliative and hospice… more
- Battelle Memorial Institute (Arlington, VA)
- …and organizational objectives. We will support positive programs for equal treatment of all staff and full utilization of all qualified employees at all levels ... and Analytics (HRA) business line is seeking a highly motivated, full-time **Licensed Clinical Social Worker (LCSW)** to join our team in support of our government… more
- Alameda Health System (Oakland, CA)
- Clinical Nurse V + Oakland, CA + Highland General Hospital...FQ MCH/OB Clinic (K6) + Full Time - Day + Management + $64.00- $96.00 + Req #:42878-31844 + FTE:1 + ... the giving of patient care and the promotion of staff satisfaction. Makes regular rounds to all patient areas...nursing unit for which responsible. Promotes effective and economic utilization of personnel and supplies. Monitors utilization … more
- Stanford Health Care (Palo Alto, CA)
- …area. + Knowledge of basic business aspects of position, such as utilization management , charging practices and regulatory practice compliance. + Knowledge ... populations. + Develops content for clinical teaching, including the clinical instruction of interns/students, residents, and other staff ; prepares and… more
- Alameda Health System (Oakland, CA)
- Clinical Nurse IV + Oakland, CA + Highland General Hospital + Emergency + Full Time - Night + Management + TBD + Req #:43134-32050 + FTE:1 + Posted:November 4, ... other crisis situations. Contacts appropriate persons and gives directions to hospital staff . 3. Assures the establishment and maintenance of a system of… more
- CEDARS-SINAI (Beverly Hills, CA)
- …change. Manages the department's fiscal budget including effective expense reduction, utilization management , budget control and new revenue generation. Manages ... coordination of the department, for which they have responsibility, including clinical practice, research operations, human resource management , fiscal… more
- Monte Nido (White Plains, NY)
- …opportunity for people to realize their healthy selves. **Eating Disorder Clinical Director** **Monte Nido Eating Disorder Center of Westchester** **White Plains, ... in group and individual therapy, benefit from Monte Nido's clinical , medical, psychiatric and nutritional expertise and experience real...habits by eating meals to completion with clients and staff while working at mealtimes. + At times, the… more
- Oregon State University (Portland, OR)
- …Department Pharmacy Professnl Instr (PHR) Position Title Assistant/Associate Professor ( Clinical ) Job Title Assistant/Associate Professor ( Clinical ) Appointment ... a full-time (1.00 FTE ), 12-month, fixed-term, Assistant or Associate Professor ( Clinical ) position. Reappointment is at the discretion of the Department Head.… more
- Harbor Health Services, Inc. (Mattapan, MA)
- …and maximize quality. Develops metrics to monitor and manage the performance of all utilization management functions and staff accountable for performance on ... for more than 580 participants. We are currently seeking a Director of Utilization Management & Quality Programs. Harbor Health offers an excellent,… more
- ERP International (Luke AFB, AZ)
- …algorithms, CM software, and databases for community resources. - Integrate CM and utilization management (UM) and integrating nursing case management with ... Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health Services… more
- Luke Staffing (Yigo, GU)
- … clinical nursing experience is required. One year of previous experience in Utilization Management is required. Full time employment in a nursing field ... of this position, it must be directly related to referral/ utilization management . + **Licensure:** Current, full, active,...of all referrals. + Orients and trains other Referral Management Center (RMC) staff . Provides RMC … more
- Seattle Children's (Seattle, WA)
- …pasteurization, human milk and formula delivery, medical food and product inventory management , utilization of electronic health record and milk management ... protocols and policies. Provide customer service to patients, visitors, and staff according to hospital and department expectations. Demonstrates understanding of… more
- Stanford Health Care (Palo Alto, CA)
- …+ Lead Work -- May lead the work of administrative/ clinical support staff responsible for assisting with case management for an assigned patient caseload. ... regarding the discharge planning process and applicable regulatory requirements; educates the staff on case management ; and provides specific information related… more
- Stanford Health Care (Palo Alto, CA)
- …regarding the discharge planning process and applicable regulatoryrequirements; educates the staff on case management ; and provides specific information related ... + Lead Work -- May lead the work of administrative/ clinical support staff responsible for assisting with...activities by identifying opportunities forimprovement in such areas as clinical outcomes, utilization of resources and concurrent… more
- Parexel (Juneau, AK)
- …Data Management Lead to join our team. If you have a passion for clinical research, strong project management skills, and a knack for data management , ... Science, OR equivalent industry experience. + 7+ years experience in pharmaceutical/biotech clinical data management / Biometrics ( clinical trial data… more
