- Humana (Frankfort, KY)
- …our caring community and help us put health first** The Director of Utilization Management ( UM ) Cost of Care Strategy provides data-based strategic ... for business segments or the company at large. The Director of Utilization Management ( UM ) Cost of Care Strategy requires an in-depth understanding of… more
- LA Care Health Plan (Los Angeles, CA)
- …that purpose. Job Summary Under the general direction of the Director of Utilization Management ( UM ) the Program Manager II is responsible for leading ... Utilization Management Program Manager II Job...Expected to serve as a strategic thought partner with director and senior management leadership team members… more
- CVS Health (Springfield, IL)
- … in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds ... support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical Utilization Management ( UM ) provides comprehensive ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/160505/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …assistance, annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** 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… more
- Evolent Health (Columbus, OH)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Director , Utilization Management , you'll work with your managers, front line ... and efficiencies for our members, providers, and customers. **Collaboration Opportunities:** The Director , Utilization Management , will partner with a… more
- AmeriHealth Caritas (Orlando, FL)
- …and related policy and practice initiatives in collaboration with the Corporate Medical Director (s), Senior Medical Directors, Utilization Management and the ... **Medical Director , UM Review, Family Medicine** Location:...Family Medicine** Location: Orlando, FL Primary Job Function: Medical Management ID**: 31409 **Job Brief** Must be able to… more
- Apex Health Solutions (Houston, TX)
- …or Licensed Vocational Nurse required and current unrestricted Certification in Utilization Review/ Utilization Management preferred Experience / Knowledge ... and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM... management cases or situations to the Medical Management Manger/ Director for immediate intervention or investigation.… more
- Elevance Health (Atlanta, GA)
- …Preferred Skills, Capabilities and Experiences: + Pediatric clinical experience strongly preferred. + Utilization Management experience highly desirable. ... clinical program and/or independently performs clinical reviews. + The Medical Director typically has program management responsibilities including clinical… more
- Elevance Health (Nashville, TN)
- …clinical program and/or independently performs clinical reviews. + The Medical Director typically has program management responsibilities including clinical ... of one of our Elevance Health locations.** The Medical Director is responsible for the administration of physical and/or...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- Elevance Health (Las Vegas, NV)
- …entire clinical program and/or independently performs clinical reviews. The Medical Director typically has program management responsibilities including clinical ... partnership with blue cross blue shield plans. The Medical Director is responsible for the administration of physical and/or...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- LA Care Health Plan (Los Angeles, CA)
- …the safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day ... Supervisor, Utilization Management RN Job Category: Clinical...LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists … more
- Guthrie (Sayre, PA)
- Position Summary: The Utilization Management ( UM ) Reviewer, in collaboration with other internal and external offices, payors, and providers and staff, is ... responsible for the coordinates Utilization Management ( UM ) processes and...the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. a) Serves… more
- Intermountain Health (Las Vegas, NV)
- …health plan criteria, MCG criteria, and state, local, or federal guidelines relating to utilization management . + Demonstrated knowledge of case management , ... Reviewer, you are responsible, in partnership with the Sr. Director of UM and the Director...work experience related to inpatient management , case management , utilization management , quality … more
- YesCare Corp (Bartow, FL)
- …Veterans._ **Responsibilities** Below is a list of your responsibilities as a ** Utilization Management Coordinator** with YesCare: + Confirms admissions with ... outside hospitals and notifies the Utilization Management Department of need to report...requests for outpatient services, codes, and forwards to Corporate UM Medical Director + Performs monthly audit… more
- Trinity Health (Darby, PA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Appeals and Utilization Management Coordinator under direction and in collaboration with ... the RN Care Coordination Manager, provides support to the utilization management , denials and appeals process for...and state laws, and department policies + Collaborates with UM Manager to establish efficient workflow processes to ensure… more
- Huron Consulting Group (Chicago, IL)
- …as the expert you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring the appropriate ... to facilitate optimal patient outcomes while managing healthcare costs. The Utilization Management Specialist ensures compliance with regulatory requirements and… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will...and reports are maintained and referred to the Physician Advisor/ UM Director . Documents in platform/system of record.… more
- Immigration and Customs Enforcement (IN)
- …and external stakeholders (eg, Customs and Border Patrol, Veterans Affairs) regarding utilization management ( UM ) processes, trainings, and principles to ... Director for Healthcare Compliance, Office of Health Plan Management . The Senior Utilization Review Consultant will...related issues c. Collection, review, tracking, and reporting of UM related data on a local, regional, and national… 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 ... starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! RN - Utilization Review (Full-time/Billings) CARE MANAGEMENT (Billings Clinic… more