- Community Based Care of Brevard, Inc. (Osceola County, FL)
- Salary: $67,000/year Position Summary: The UM Program Manager provides oversight and management of service authorization data validation, reporting and trend ... line-by-line entries, and submits to finance for payment. The UM Program Manager reconciles ARGOS Dependency Cases...Function : Collect, analyze, and summarize data within the Utilization Management System to prepare reports for… more
- CVS Health (Pittsburgh, PA)
- …to make health care more personal, convenient and affordable. Position Summary The Utilization Management ( UM ) clinical development pharmacist will develop ... will interact with several key areas including Clinical Operations, Clinical Account Management , Formulary Administration, and Clinical Affairs. The UM Clinical… 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...providers and other physicians about the Health Solutions case management referral program as potential enrollees are… more
- AmeriHealth Caritas (Orlando, FL)
- …in collaboration with the Corporate Medical Director(s), Senior Medical Directors, Utilization Management and the Vice President, Medical Affairs. The ... **Responsibilities:** Provide organizational leadership in the operational areas of care management , utilization review, appeals, quality improvement and related… more
- Molina Healthcare (Nacogdoches, TX)
- …+ Performs monthly auditing of registered nurse and other clinical functions in Utilization Management ( UM ), Case Management (CM), Member ... **Required Education** Completion of an accredited Registered Nurse (RN) Program and Associate's or bachelor's degree in Nursing OR...years of experience in case management , disease management or utilization management in… more
- Textron (Wichita, KS)
- **Unit Member \( UM \) / Designated Engineering Representative \(DER\) \- Avionics & Electrical Systems Engineering \- Defense & Special Missions** Textron Aviation ... performed by Engineering support groups, Experimental, Manufacturing and Supply Chain Management for the project + Instructs suppliers as to materials, equipment… more
- Textron (Wichita, KS)
- **Unit Member \( UM \) / Designated Engineering Representative \(DER\) \- Avionics & Electrical Systems Engineering** Textron Aviation has been inspiring the journey ... performed by Engineering support groups, Experimental, Manufacturing and Supply Chain Management for the project\. + Instructs suppliers as to materials, equipment… more
- Molina Healthcare (Spokane, WA)
- …discharge. Experience with the adult behavioral health system in Washington State and Utilization Management ( UM ) experience is highly preferred** . ... position is to support the Community Behavioral Health Supports Program in Washington State. We are seeking a candidate...social work. **Required Experience** + 1-3 years in case management , disease management , managed care or medical… more
- LifePoint Health (Las Cruces, NM)
- …utilizes hospital resources in the development of care, discharge planning and Utilization Review. * Utilization Management performs prospective, admissions, ... observation and concurrent review according to standard policies and procedure. * Utilization Management reviews and analyze processes designed to ensure… more
- CVS Health (Salt Lake City, UT)
- …and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications - Valid unrestricted ... Pacific Time (PST), or Arizona time zones. As a UM Clinician Behavioral Health you will: - Utilize clinical...to promote quality effectiveness of healthcare services and benefit utilization . - Consult and lend expertise to other internal… more
- Centers Plan for Healthy Living (Jamaica, NY)
- …with the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to ... UM Care Coordinator 90-27 Sutphin Blvd, Jamaica, NY...of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members. PRIMARY… more
- CVS Health (Topeka, KS)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program . + Utilizes clinical experience and ... 5+ years of clinical experience + 1+ year(s) of utilization management , concurrent review and/or prior authorization...for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed… more
- Elevance Health (Atlanta, GA)
- …independently performs clinical reviews. + The Medical Director typically has program management responsibilities including clinical policy development, ... Preferred Skills, Capabilities and Experiences: + Pediatric clinical experience strongly preferred. + Utilization Management experience highly desirable. more
- Sharp HealthCare (San Diego, CA)
- …position, and employer business practices. **What You Will Do** To provide comprehensive utilization management and coordination of care for members who are ... : Graduate of an accredited Licensed Vocational Nurse (LVN) program + 3 Years experience in the acute patient...plan requirements for documentation of concurrent SNF review and utilization management activities performed in a manner… more
- CVS Health (Albany, NY)
- …and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with ... to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal...for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed… more
- Elevance Health (Las Vegas, NV)
- …and/or independently performs clinical reviews. The Medical Director typically has program management responsibilities including clinical policy development, ... Director Associates. May be responsible for an entire clinical program . **This position will work a hybrid model (remote...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- Elevance Health (Louisville, KY)
- …independently performs clinical reviews. + The Medical Director typically has program management responsibilities including clinical policy development, ... Director Associates. May be responsible for an entire clinical program . How you will make an impact: + Supports...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- The Cigna Group (Franklin, TN)
- …state departments of insurance, and similar accreditors/regulators for the performance of all utilization management ( UM ) programs across the enterprise. The ... The Chief Medical Officer (CMO) Utilization Management will develop and manage...UM programs, including matters concerning clinical policy, quality management (QM), program development, review of … more
- Stanford Health Care (Palo Alto, CA)
- …assistance! **This is an onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse ( UM RN) will be responsible for ... the institution, navigating the complexities of patient care and resource utilization management , and education. Primary responsibilities include: 1.… 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...department's performance measures outcomes and goals. Plans and oversees UM activities according to model of care, program… more