- Wisconsin Community Services (Milwaukee, WI)
- …Attention recent graduates! Working as a Case Manager in our Targeted Case Management program offers many unique opportunities and benefits: *Our Case Managers serve ... those who are often overlooked and underserved. *MSW graduates - Earn your 3,000 clinical hours towards licensure (LCSW or LPC). *Many licensing fees and CEUs are… more
- Centene Corporation (Sacramento, CA)
- … Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… 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 ... internal partners (eg, Provider Relations, Quality) to resolve escalations and address utilization management issues. + Represent UM nursing team in internal… more
- CareFirst (Baltimore, MD)
- …programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Utilization Management **Equal Employment ... **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination… more
- Point32Health (MA)
- …. **Job Summary** Under the direction of the Pharmacy Utilization Management (UM) Supervisor , the Clinical Pharmacist is responsible for ... authorization (PA) requests for coverage determinations (CD), and exceptions. The Clinical Pharmacist ensures timely disposition of reviews for CD and exceptions… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to ... staff, members and providers. + Provides backup for the Supervisor , whenever necessary. Participates in the orientation of new...Bachelors degree preferred. + Minimum of three years of clinical experience required. Utilization Management … 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
- Saint Francis Health System (Tulsa, OK)
- …not all inclusive nor does it prohibit the assignment of additional duties. Utilization Management - Laureate Campus Location: Tulsa, Oklahoma 74136 **EOE ... through Friday, 8:00 am to 5:00 pm** Job Summary: Provides administrative and clinical support to the hospital and treatment team throughout the review of patients,… more
- AmeriHealth Caritas (LA)
- …Under the direction of the Supervisor , the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity ... reviews. Using clinical knowledge and experience, the clinician reviews provider requests...and American Society of Addiction Medicine (ASAM) criterion + Utilization management experience within a managed care… more
- Sedgwick (Cincinnati, OH)
- …(2) years of recent clinical practice or one (1) year of recent utilization review. **Skills & Knowledge** + Strong clinical practice knowledge + Knowledge ... Fortune Best Workplaces in Financial Services & Insurance RN Utilization Review **Join us in a hybrid capacity, combining...and works with claim examiners as needed to provide clinical information to resolve issues. + Maintains a score… more
- Helio Health Inc. (Syracuse, NY)
- …Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management ... track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our Inpatient,… more
- University of Rochester (Rochester, NY)
- …Staff Pharmacist - Clinical Responsibilities_** + In coordination with the clinical pharmacy team, oversees the management of drug shortages in the ... conduct the business of the functional unit under their supervision and management . Their supervisor should be aware of all ongoing interdepartmental… more
- WMCHealth (Valhalla, NY)
- Supervisor Of Nursing - Clinical Care Management Company: Westchester Medical Center City/State: Valhalla, NY Category: Nursing/Nursing Management ... Details: N4 Supervisor of Nursing/Nurse Manager - Clinical Care Management Internal Posting: 12/03/25 to...the procedures specified in the Clinical Care Management Department through review of the Utilization … more
- BayCare Health System (Tampa, FL)
- …built on a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities ... + Community discounts and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review RN **Location** Tampa:St Josephs | Clinical |… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title:** **Social Worker - Emergency Dept (High Utilization )** **_Social Work Services at the Mount Sinai Hospital_** The Mount Sinai ... repeat ED visits and limited access to community-based care. + Excellent clinical skills, with exceptional skills in rapid psychosocial assessment and focused… 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 ... a salary, based on specific SUD / supervisory experience, starting at $65,000. The Clinical Supervisor is accountable to the Director of the Substance Use… more
- University of Southern California (Arcadia, CA)
- …of the RN staff, and assists the Director and/or Manager with the operational management of the nursing unit. The Supervisor coordinates care of the patients ... of resources so that patient outcomes are optimized. The Supervisor serves as a professional clinical role...operations of assigned areas (budget, regulatory compliance, and resource utilization ). + Demonstrates clinical performance in the… more
- Children's Home Healthcare (Albuquerque, NM)
- …A VALID RN LICENSE* Children's Home Healthcare is now hiring for a RN Clinical Supervisor /Case Manager! Children's HH is the premier leader in Pediatric Home ... this growing professional team! We are seeking an experienced Clinical Supervisor in the Albuquerque area. The...skills and willing to travel to patient homes + Utilization Management Experience + Reliable transportation for… more
- Boston University (Boston, MA)
- **FLOATING CLINICAL CARE SUPERVISOR , School of Dental Medicine, Clinical Affairs** **Job Description** **FLOATING CLINICAL CARE SUPERVISOR , School of ... compensation at the time of posting. **Position Type** Full-Time/Regular The Floating Clinical Care Supervisor is responsible to manage, provide guidance and… more
- Northeast Alabama Regional Medical Center (Anniston, AL)
- … clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred. Extensive knowledge and understanding of medical ... Under the direction of the Case Management Coordinator, coordinates, negotiates, procures and manages the care of patients to facilitate achievement of positive … more
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