- Commonwealth Care Alliance (Boston, MA)
- …cases. + Member of health plan QI Committee. Co-chair of health plan Utilization Management Committee **Working Conditions:** + Standard office ... in daily operations. Responsible for resolution and communication of utilization management issues and concerns and corrective action plan activities and… more
- Adecco US, Inc. (Minneapolis, MN)
- …liaison between Health Plan delegated entities and Clinical Services Operational teams ( Utilization Management and Case Management ) * Serves as a liaison ... Adecco Healthcare & Life Sciences is hiring for a ** Utilization Management ** **LPN** to work **remotely** !...LPN:** * In collaboration with the Manager of Delegation Oversight , manages delegation oversight and regulatory audits.… more
- Ascension Health (Nashville, TN)
- …Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan . + Ensure ... **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours week. + **Hospital:** Ascension Saint Thomas + **Location:**… more
- Humana (Salem, OR)
- …of our caring community and help us put health first** The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, ... communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and… more
- Scottish Rite for Children (Dallas, TX)
- …for services provided, + Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization ... children back their childhood! Job Posting Title: Director of Case Management and Utilization Management Location: Dallas - Hospital Additional Posting… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical Utilization Management (UM) provides comprehensive ... oversight of the Utilization Review process for the self-insured Employee Health Plans,...experience in Clinical Utilization Review or Case Management with a large Health Plan +… more
- Henry Ford Health System (Troy, MI)
- …quality of care provided by the primary care team. He/she works with utilization management reports, corporate data stores, and information services to optimize ... GENERAL SUMMARY: The Pharmacy Specialist provides oversight and leadership for appropriate drug use within...+ Monitors, assesses, and improves regional drug use using utilization management reports. + Works collaboratively with… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 241106-5613FP-001 Location East Hartford, CT Date Opened 11/7/2024 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) position, located… more
- CVS Health (Springfield, IL)
- …convenient and affordable. **Position Summary:** The Associate Manager is responsible for oversight of Utilization Management /Case Management staff. ... Registered Nurse + 3+ years of Managed Care experience + 1+ years of Utilization Management experience + 1+ year Leadership experience (formal or informal roles)… more
- Katmai (Usaf Academy, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... background checks. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in… more
- Henry Ford Health System (Detroit, MI)
- …DNB numbers 2. Ensure correct patient status for hospitalized patients 3. Chair Utilization Management Committee: a. Reviewing outlier data, observation LOS b. ... Utilization Review is responsible for the medical oversight of activities related to appropriateness of Henry Ford...updates, and LOS initiatives 13. Ensure compliance with CMS Utilization Management Conditions of Participation (COP) 14.… more
- Henry Ford Health System (Troy, MI)
- …Pharmacy Benefits Coordinator facilitates the operations of the Pharmacy Care Management department by organizing, improving, and implementing pharmacy benefit ... management policies and procedures. Major areas of responsibility include oversight of the claims processing system, development of new benefit designs and… more
- Citigroup (Tampa, FL)
- The Audit Plan Oversight Lead Analyst will support the growth of Internal Audit's planning process, building strong partnerships with key stakeholders across IA, ... aims as well as meeting regulatory expectations. The Audit Plan Oversight Lead Analyst will partner with...Team, and the Product/Function in ensuring that the assurance plan is properly aligned with staff utilization .… more
- Prime Healthcare (Ontario, CA)
- …Nurse (LVN) license. + Minimum two years of experience in acute hospital case management or equivalent. + Utilization Management experience required. + ... education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/176615/ utilization -review-nurse-lvn/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management Inc… more
- The Cigna Group (Bloomfield, CT)
- …Medicare and Medicaid regulations to determine the outcome of the appeal; provide oversight and assistance to Medical Management staff with resolution of appeal ... perform all appeal related duties in a Medicare Advantage Plan . These appeals will include requests for decisions regarding...limited to: + Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare… more
- Veterans Affairs, Veterans Health Administration (Chillicothe, OH)
- …Duties and responsibilities include but are not limited to: Provides leadership and oversight of Risk Management Programs to improve patient outcomes and reduce ... Nurse (RM/UM) is responsible for the Medical Center Risk Management Program which identifies risk that may adversely affect...three core elements, seeking to create a personalized health plan for each Veteran. This is done in the… more
- JPMorgan Chase (Newark, DE)
- **Job Description** As a Data Management Lead, VP on the CIB Chief Data Office (CDO), you will manage a growing team recognized for its thought leadership and ... CIB Data Retention and Destruction (R&D) Team provides central oversight and governance of R&D Data Risks in accordance...R&D Data Risks in accordance with Firmwide Data Risk Management Policy and Standard. The R&D Team partner closely… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Regulatory Affairs team. This **Director of Regulatory Compliance and Third-Party Oversight ** will work proactively to develop, enhance, and implement Premera ... Blue-Cross's enterprise-wide Compliance and Ethics Program and provide oversight to compliance of services via third parties. **What you will do:** **Provide… more
- Truist (Charlotte, NC)
- …implemented, executed, and sustained. 7. Drive and execute the Program staffing plan including oversight of and participation in the recruiting, hiring ... key contributor to the Truist second line-of-defense (LoD2) Enterprise Data Risk Oversight (EDRO) team reporting to the Data Risk Control Director. Responsible for… more
- Ventura County (Ventura, CA)
- …as requested. + Attends the meetings of the Standing Committee, the Plan 's oversight committee. Presents the Plan 's Utilization and Quality Reports and ... medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality Assurance Staff. + Participates, as… more