- Centene Corporation (Sacramento, CA)
- …between utilization management team, members, and providers + Monitors prior authorization , concurrent review, and/or retrospective clinical review nurses ... a fresh perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization , Concurrent Review, and/or Retrospective Review Clinical… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team ... driving compliance with organizational, state, and federal requirements. The Supervisor balances hands-on operational responsibilities with leadership duties, serving… more
- Commonwealth Care Alliance (Boston, MA)
- …Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency… more
- Penn Medicine (Lancaster, PA)
- …role to meet department needs. + Provide periodic staff updates to the Supervisor . + Verify eligibility and obtain authorization through telephonic interaction ... by providing authorization information and or billing details. + Assists Utilization Management on high priority accounts by obtaining or updating the … more
- University of Rochester (Rochester, NY)
- …as defined by NYS Laws and Regulations. The Pharmacy Medication Utilization and Inventory Compliance Manager has direct supervision and management responsibilities ... in medication dispensing. **ESSENTIAL FUNCTIONS** **_Clinical Staff Pharmacist - Medication Authorization and Distribution_** + Directs and supervises the work of… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Coordinator Supervisor oversees the day-to-day operations and performance of the UM Coordinator team. This position ensures that ... and in accordance with health plan, regulatory, and NCQA standards. The Supervisor provides daily coaching, quality review, and workflow oversight while fostering… more
- Samaritas (Charlotte, MI)
- Position Details MENTAL / BEHAVIORAL HEALTH CLINICAL SUPERVISOR - Eaton County Are you a licensed clinician with a passion for supporting recovery and leading ... others? Join our mission-driven team as a Clinical Substance Use Disorder Supervisor , where your leadership will directly impact lives and shape the future of… more
- Mohawk Valley Health System (Utica, NY)
- … is responsible for the oversight of the case management staff's authorization /coordination/ utilization and provision of member services. Duties include the ... Case Management Supervisor - Full Time - Days Department: CASE...direct oversight of the case manager's daily operations of utilization review practice, process and procedures ensuring accurate member… more
- Mohawk Valley Health System (Utica, NY)
- …SNH is responsible for the oversight of the case management staff's authorization /coordination/ utilization and provision of member services. Duties include the ... RN Supervisor Case Management - Full Time - Days...direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member… more
- Air National Guard Units (Peoria, IL)
- …EXCEPTED SERVICE POSITION. This National Guard position is for a AIRCRAFT MAINTENANCE SUPERVISOR (Title 32), Position Description Number D1444000 and is part of the ... IL 182 AW, National Guard. Responsibilities As an AIRCRAFT MAINTENANCE SUPERVISOR (Title 32), WS-8801-14, you will Major Duties - This is NOT an all-inclusive list:… more
- Air National Guard Units (Milwaukee, WI)
- Summary This National Guard position is for a AIRCRAFT MECHANIC SUPERVISOR - Title 32, Position Description Number D0806000 and is part of the WI 128 MXS, Wisconsin ... Air National Guard. Responsibilities As a AIRCRAFT MECHANIC SUPERVISOR - Title 32, WS-8852-12, you will provide overall direction and coordination of the subordinate… more
- Stark County Board of Developmental Disabilities (Canton, OH)
- …billings, and utilization , as needed; this may include working with payment authorization specialists (PAS); + Submits prior authorizations prior to the ... is available for consultation with primary "on-call" SSA; + Each SSA Supervisor has responsibilities and project assignments relative their expertise and the unit… more
- WEG Electric Corp. (Duluth, GA)
- Accounts Payable Supervisor /Management Accountant **Department:** Finance **Location:** Duluth, GA About the role: ... (https://apply.hrmdirect.com/resumedirect/ApplyOnline/Apply.aspx?req\_id=3477150&source=3477150-CJB-0) The Accounts Payable (AP) Supervisor -Management Accountant will primarily oversee a small team of… more
- Point32Health (MA)
- …concurrent, and retrospective coverage requests for in-patient and out-patient services requiring prior authorization and medical necessity review for all lines ... **Job Summary** The Medical Director, Clinical reviews will primarily perform utilization management and provider payment reviews for all Point32Health products, as… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Specialist provides administrative support for any of the programs of Utilization Management, Behavioral Health, Quality Management, or Member Care Management. This ... division. + Serves as the primary contact for providers regarding authorization , information requests, claim inquiries and benefits. Provides triage assistance to… more
- Air National Guard Units (Eielson AFB, AK)
- …Air National Guard. PDCN: D2180P01 / D2181P01 MPCN: 889707 Selecting Supervisor : James G. Meyer Responsibilities GS-09 - Administers classified and unclassified ... and software and develops base wide network operating procedures. Analyzes LAN utilization statistics through data collection and performance measures to ensure the… more
- Point32Health (MA)
- …responsible for reviewing, processing and managing the daily caseload of pharmacy prior authorization (PA) requests for coverage determinations (CD), and ... . **Job Summary** Under the direction of the Pharmacy Utilization Management (UM) Supervisor , the Clinical Pharmacist...Pharmacist consults as required with Medical Directors (MD) on prior authorization that fails to meet drug… more
- UPMC (Pittsburgh, PA)
- …to pharmacy prior authorizations. Manage the first line clinical review of prior authorization requests on behalf of physicians and UPMC Health Plan members. ... and the clinical staff + Subject matter expert on formulary exceptions and prior authorization requirements/time frames according to line of business. + Perform… more
- Air National Guard Units (Fort Smith, AR)
- …are eligible for military membership, please contact a National Guard recruiter prior to applying for this position. Compatible military grade and assignment ... required prior to the effective date of placement. This is...assignment (if applicable, training will be coordinated by the supervisor ). Individual must meet all military requirements of the… more
- Air National Guard Units (Fort Smith, AR)
- …and software and develops base wide network operating procedures. Analyzes LAN utilization statistics through data collection and performance measures to ensure the ... methods and procedures and coordinates corrective action to optimize utilization of present equipment. Uses benchmarks, performance measurement, and evaluation… more
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