- Sanford Health (ND)
- …- 28.00 **Department Details** Opportunity to work remotely. **Job Summary** Monitors the utilization of resources, risk management and quality of care for ... Collection of clinical information necessary to initiate commercial payor authorization . Obtain and maintain appropriate documentation concerning services in… more
- Evolent Health (Columbus, OH)
- …Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The ** Coordinator , Intake Utilization Management ** at Evolent will serve as a ... regulatory requirements, and client contractual agreements. **Collaboration Opportunities** : The Coordinator , Intake Utilization Management reports directly… more
- ManpowerGroup (Rancho Cucamonga, CA)
- **Job Title: Utilization Management Outpatient** **Duration: 6 months** **Location: Rancho Cucamonga, CA (Hybrid, Twice in a month)** **Pay rate: $23.98/hr.** ... **We are looking for an Utilization Management Outpatient** **to join one of...standards for appropriate authorizations of referrals at the UM Coordinator level. + Responsible for representing the Inland Empire… more
- Baptist Memorial (Memphis, TN)
- Summary The Authorization Coordinator is responsible for facilitating information documentation and transmission vital to the effectiveness of utilization ... services using evidence based criteria. Areas of work include payer notification, authorization management , denial management , escalations, and communication… more
- Trinity Health (Pontiac, MI)
- …customers and community groups. **D.** **Experience** Three years recent acute care utilization management experience. Knowledge of regulations relative to ... RN licensure within the State of Michigan. Certified Professional in Utilization Review/ Management preferred. **C** **Special Skill / Aptitudes** Understanding… more
- Henry Ford Health System (Troy, MI)
- … Coordinator facilitates the operations of the Pharmacy Care Management department by organizing, improving, and implementing pharmacy benefit management ... system, development of new benefit designs and programs, organizing the prior authorization process and management of the various vendor /customer relationships.… more
- Fallon Health (Worcester, MA)
- **Overview** **The Authorization Coordinator works M - F 8 am to 5 pm/ 8:30 am to 5 pm and will require at least 6 months of training 5 days/week in the office ... NCQA standards, other applicable regulatory requirements, and customer expectations. The FH Authorization Coordinator serves to administer the FH prior … more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. Under the direction of the Utilization Management , Assistant Manager, you will play a key role in processing and ... leading health organization. Help ensure smooth and efficient case management processes to support quality care. Take your expertise...managing authorization requests. You will: + Receive urgent, routine, pre-service,… more
- TEKsystems (Baltimore, MD)
- Description: PURPOSE: Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to ... pre-service utilization review care coordination and quality of care. ESSENTIAL...provider related administrative support which may include benefit verification authorization creation and management claims inquiries and… more
- VNS Health (Manhattan, NY)
- …+ Advanced personal computer skills, including Word, Excel or Access required + Utilization Management experience preferred CAREERS AT VNS Health The future of ... authorization requests and/or activities + Communicates with Care Management , Member Services, Membership and Eligibility and other internal departments… more
- VNS Health (Manhattan, NY)
- …What You Will Do + Supervises the day-to-day operations of the non-clinical authorization team. Oversees the development, utilization , and evaluation of internal ... operations and coordinates all work activities of the non-clinical authorization team. Ensures a customer-focused operation that meets organizational standards,… more
- Spokane County (Spokane, WA)
- …Behavioral Health Administrative Services Organization Utilization Review Integrated Care Coordinator : + Performs utilization management , utilization ... practice standards for substance use disorder assessment and treatment. + Knowledge of utilization management of public behavioral health. + Knowledge of federal… more
- State of Michigan (Lansing, MI)
- Medicaid Utilization Analyst 9-12 - BPHASA MEDICAL EQUIPMENT & SERVICES SECTION Print (https://www.governmentjobs.com/careers/michigan/jobs/newprint/4741189) Apply ... Medicaid Utilization Analyst 9-12 - BPHASA MEDICAL EQUIPMENT & SERVICES...senior analyst conducting clinical reviews of applications/requests for prior authorization of clinical services, procedures, supplies, and/or equipment provided… more
- Covenant Health Inc. (Louisville, TN)
- Overview Utilization Review Coordinator , Quality Management Full Time, 80 Hours Per Pay Period, Day Shift Peninsula Overview: Peninsula, a division of ... budgeted targets. + Provides medical/psychiatric leadership/consultation to Provider Relations, Medical Utilization Management , and Quality Management Staff… more
- Banner Health (AZ)
- …you're looking to leverage your abilities - you belong at Banner Health. The utilization Management Representative will process clinicals to send to payers while ... care. POSITION SUMMARY This position assists in the administration of Utilization Management functions to include organization of workflow, communications… more
- Baptist Memorial (Jackson, MS)
- …include status management , medical necessity reviews, verification of authorization , resource utilization , and denial prevention. Responsibilities + ... Summary The Utilization Review Nurse is responsible for evaluating the...queues in the electronic medical record + Communicates with authorization coordinator + Communicates in-house high dollar… more
- Corewell Health (Taylor, MI)
- …of care and cost effectiveness through the integration and functions of utilization management , and/or care coordination, discharge planning, and appropriate ... Care Coordinator for Rehab Services PRN/Casual position- hours will...managing a case load of patients that includes facilitating utilization management , and/or care coordination during the… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …resolves as needed. * Serves as subject matter expert (SME) for non-clinical authorization activities within the utilization management department. * ... UM Coordinator team providing direct guidance and support with authorization creation, caller escalation and investigation of complex cases. The UM supervisor… more
- ChenMed (Morrow, GA)
- …market leaders, external clients and HMO to establish, maintain and support outpatient utilization management in PMR and delegated utilization management ... necessary. **_Other responsibilities may include:_** + Drive the current delegated/non-delegated utilization management model to a sustainable and reproducible… more
- ChenMed (Portsmouth, VA)
- …market leaders, external clients and HMO to establish, maintain and support outpatient utilization management in PMR and delegated utilization management ... necessary. **_Other responsibilities may include:_** + Drive the current delegated/non-delegated utilization management model to a sustainable and reproducible… more
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