- Centene Corporation (Madison, WI)
- …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 + Maintains… more
- Centene Corporation (Richmond, VA)
- …a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of policy ... and processes to help support best member outcomes. Oversees and manages Utilization Operations specific to the daily operations of Utilization Management… more
- CVS Health (Austin, TX)
- …+ Job Description Primary Job Duties & Responsibilities Drives effective utilization management practices by ensuring appropriate and cost-effective allocation of ... and facilitating appropriate healthcare services/benefits for members. Conducts routine utilization reviews and assessments, applying evidence-based criteria and clinical… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... with meeting the organization's goals and objectives for assuring the effective, efficient utilization of health care services. This role will be an expert on… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR ... direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I ... comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're working… more
- New York State Civil Service (Syracuse, NY)
- NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), Hutchings Psychiatric Center, P26038 Occupational Category Health Care, ... 13210 Duties Description Hutchings Psychiatric Center is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Utilization Management Full Time, 80 Hours Per Pay Period, Day Shifts Covenant Health Overview: Covenant Health is the region's ... be named a Forbes "Best Employer" seven times. Position Summary: The RN Utilization Management I will perform utilization management functions to include medical… more
- Fallon Health (Worcester, MA)
- …strategic leadership and oversight responsibility for the clinical and operational utilization management activities for all inpatient and outpatient care, and staff ... across all product lines. **Responsibilities** ** Utilization Management:** + Oversees all administrative, operational and clinical functions related to outpatient… more
- LifeCenter Northwest (Bellevue, WA)
- …Position Type Full Time Description and Qualifications The Manager, Organ Utilization (OUM) provides strategic leadership and operational oversight for the Organ ... Utilization Coordinator Team (OUCT), directing key aspects of abdominal...directing key aspects of abdominal organ allocation, logistics, and utilization for transplantation and research. This role is accountable… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work onsite. ... position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include supervising… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... services to ensure compliance with utilization management policies. This role conducts admission and continued stay reviews, supports denials and appeals activities,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …REVISED FTE *_SUMMARY:_* We are currently seeking a*Staff Nurse*to join our Utilization Management department for the/Emergency Department / This position is a*0.6 ... and may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the… more
- Huron Consulting Group (Chicago, IL)
- …expert you are now and create your future. The Manager of Utilization Management is responsible for planning, organizing, developing, and directing implementation of ... the Utilization Review Plan and the overall operation of the Utilization Management Department in accordance with federal, state and local guidelines, regulatory… 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. ... analyze data, and develop recommendations to resolve problems related to the appropriate utilization of patient care services at the appropriate level of care. +… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + ... **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic… more
- UNC Health Care (Morrisville, NC)
- …unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible for ... designing, implementing, and standardizing utilization management functions across a large healthcare system, including a complex academic health system and multiple… more
- UNC Health Care (Raleigh, NC)
- …episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance with… more
- St. Peters Health (Helena, MT)
- The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN supports the UR RN Coordinator and other UR team members in ... providing all identified utilization review functions for the organization to ensure cost...care delivery. The UR LPN is responsible for completing utilization reviews, referral to MD advisor service(s) to allow… more
- UnityPoint Health (Cedar Rapids, IA)
- …Overview This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a ... coordinating the department's interdisciplinary effort to assess and promote appropriate utilization of health care resources, provision of high-quality health care,… more
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