- CareFirst (Baltimore, MD)
- …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... utilization management team and is responsible for the design, assessment,...distinct units: Commercial UM intake and call center, Commercial outpatient medical pre-authorization review, Commercial inpatient and outpatient… more
- Catholic Health Initiatives (Lexington, KY)
- …can happen both inside our hospitals and out in the community. **Responsibilities** The Utilization Management (UM) Director is responsible for the market(s) ... development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the CommonSpirit Health Care Coordination… more
- Ascension Health (Nashville, TN)
- …to Ascension Saint Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this ... **Details** + **Department:** Utilization Management + **Schedule:** Monday -...and fully insured clients to implement and manage comprehensive outpatient and inpatientutilization management programs. + Oversee… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/172723/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
- Health First (Viera, FL)
- …**Executive Management * **Organization:** **Holmes Regional Medical Center* **Title:** * Director - Outpatient Rehab and Fitness * **Location:** *Florida ... of outpatient rehabilitation and fitness services to our community. The Director of Outpatient Rehabilitation and Fitness advocates for performance and… more
- ERP International (Nellis AFB, NV)
- …years of total nursing experience in a direct patient care clinical inpatient and outpatient setting. Must have utilization management experience for 2 years ... No Call, No Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific Quality… more
- Fresenius Medical Center (Florissant, MO)
- …staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and ... by working with the Vice President of Quality and other organization management to ensure that organization/ASC policies and procedures are followed. + Responsible… more
- Elevance Health (FL)
- …and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience, which includes a minimum of 2 years ... **JR133557 Manager II Behavioral Health Services ( Utilization Management for Behavior Analysis Services)**...to ensure medical necessity and appropriateness of care for inpatient/ outpatient BH services; ensures appropriate utilization of… more
- LA Care Health Plan (Los Angeles, CA)
- …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II...data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical ... any time with or without notice. Primary Responsibilities * Perform prospective utilization reviews and first level determinations for members using evidenced based… more
- Billings Clinic (Billings, MT)
- …leadership and Physician Advisor, per department process or procedure Insurance and Utilization Management Maintains working knowledge of CMS requirements and ... - 44.18 Under the direction of department leadership, the Utilization Review/ Management RN. This position is...of tasks. Priority 1: Reviews New Admissions, Observation and Outpatient Cases Prioritize reviews of all OBS and bedded… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... particular department/unit. This includes, but is not limited to, the management of: + Program-specific applications, quality improvement, staff education, medical… 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
- Sharp HealthCare (San Diego, CA)
- …time for routine, urgent and expedited referrals as outlined in SCMG's Utilization Management Plan.Decisions will be communicated to the appropriate persons ... + Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, established criteria such as… more
- Martin's Point Health Care (Portland, ME)
- …Nurse required; BSN preferred. + 3+ (total) years clinical nursing experience + Utilization management experience in a managed care or hospital environment ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a...outcomes for those enrollees with a need for inpatient/ outpatient authorizations. This position receives and reviews prior authorization… more
- Trinity Health (Maywood, IL)
- …preauthorization requests utilizing defined criteria. Collects, analyzes and communicates relevant utilization management information to insurers and third party ... our small but mighty team to guide and manage Utilization Review and Management for the Loyola...desired as well as experience with inpatient UR and/or outpatient referral authorizations. **Great opportunity for a Lead Care… more
- BayCare Health System (FL)
- …+ Strong utilization of medical terminology and anatomy. + Assists Manager/ Director with mentoring/training of Coder I and Coder II team members and clinical ... + Required High School or equivalent + Preferred Associate's in Health Information Management **Experience** + Required 5 years of Outpatient Coding Equal… more
- Veterans Affairs, Veterans Health Administration (Muskogee, OK)
- …direct supervision to the Nurse Managers/Supervisors over the following units: Case Management and Utilization Management , Emergency Department, Operating ... a 61-bed hospital located in Muskogee as well as six community based outpatient clinics located in Tulsa, Bartlesville, Claremore, Vinita, McAlester and Idabel. In… more
- Arms Acres (Bronx, NY)
- …skills) as identified in patient treatment plans and requested by program director . Performs utilization review, provides progress reports and develop aftercare ... Bilingual Case Manager, Outpatient Bronx, NY (http://maps.google.com/maps?q=3584+Jerome+Avenue+Bronx+NY+USA+10467) Apply Description Are you looking to be a part of… more
- Ventura County (Ventura, CA)
- …and communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more