- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews on ... any time with or without notice. Primary Responsibilities * Perform prospective utilization reviews and first level determinations for members using evidenced based… more
- Cleveland Clinic (Beachwood, OH)
- …three years equivalent full-time clinical experience as a Registered Nurse . + Prior Utilization Management experience is preferred. + Knowledge of ... The Utilization Management Specialist, Pharmacy provides a...Management Program. This individual performs activities which includes prior authorization for medication coverage including appeals, follow up… more
- Veterans Affairs, Veterans Health Administration (Lebanon, PA)
- …clinical denials. Provides feedback as appropriate, for performance improvement, utilization management , and compliance related issues. Conducts precertification ... Revenue, Billing, Insurance Verification, Veteran Services, Compliance, Providers, Health Information Management (HIM), Utilization Management (UM), and… more
- Ascension Health (Tulsa, OK)
- **Details** + **Department:** Utilization Management + **Schedule:** FT, Monday-Friday, 8am-5pm + **Hospital:** Ascension St. John Medical Center + **Location:** ... Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. Responsibilities: +… more
- Katmai (Usaf Academy, CO)
- …Bachelor of Science in Nursing (BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, ... licensed in Colorado, be able to practice using a nurse compact state license or have a license from...checks. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional… more
- US Tech Solutions (Chicago, IL)
- …an RN + Registered Nurse in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST HAVE ... and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1...Prior Authorization? + Do you have experience with Utilization Review? + Do you have an Active Registered… more
- US Tech Solutions (May, OK)
- …experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT platforms/systems ... and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization. Education: . Active and unrestricted RN licensure… more
- Centene Corporation (New York, NY)
- …and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a ... **Must have a New York State license or identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all… more
- Sanford Health (SD)
- …- 28.00 **Department Details** opportunity to work remote **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients ... multiple administrative duties including accurate record keeping and electronic data management when needed. Ability to work with growth and development needs… more
- Centene Corporation (Cheyenne, WY)
- …key initiatives and to facilitate on-going communication between utilization management team, members, and providers + Monitors prior authorization, ... Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure… more
- Centene Corporation (Tallahassee, FL)
- …licensure as outlined by the applicable state required. Knowledge of BH utilization management principles preferred. Prior supervisory experience preferred ... care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours week. + **Hospital:** Ascension Saint Thomas + **Location:** ... TN market. We're looking for an experienced Director of Utilization Management to join our team! In...management programs. + Oversee implementation and maintenance of prior authorization codes for all clients. **Requirements** Licensure /… more
- Hackensack Meridian Health (Hackensack, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to...regulatory guidelines (ie., Important Message 4 to 48 hours prior to discharge, appeal and HINN notices). + Maintains… more
- Independent Health (Buffalo, NY)
- …perks, benefits and commitment to diversity and inclusion. **Overview** The Program Manager- Utilization Management (UM) will be accountable for the management ... assess and make recommendations for improvements to maintain an effective and efficient utilization management process, as well as manage medical expenses based… more
- Hackensack Meridian Health (Holmdel, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to...regulatory guidelines (ie., Important Message 4 to 48 hours prior to discharge, appeal and HINN notices) + Maintains… more
- Sanford Health (Fargo, ND)
- … and potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality of care for patients in ... Range:** $27.50 - $38 **Department Details** We are seeking a dedicated and detail-oriented Utilization Management Specialist RN to join our team. In this remote… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...Critical Care Nursing experience required + Previous experience in utilization management required + Prior … more
- Evolent (Columbus, OH)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Intake … more
- Ascension Health (Kalamazoo, MI)
- … experience preferred. **Additional Preferences** There will be a dual focus on case management and utilization review in this position + Case Management ... **Details** + **Department:** Case Management + **Schedule:** Monday through Friday; Day shift...from the Commission for Case Manager Certification (CCMC) obtained prior to hire date or job transfer date. +… more
- Elevance Health (Miami, FL)
- ** Utilization Management Representative II** **Location:** Must live within 50 miles of the Miami or Tampa Florida PulsePoint. The ** Utilization ... benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests. + Obtains intake… more