- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 Your career starts now. ... Officer for the Ohio Market, this position is representing Utilization Management (UM) in state interactions/audits, validation... program. + Act as a primary liaison with plan providers including but not limited to physicians, hospital… more
- LA Care Health Plan (Los Angeles, CA)
- …experience in a patient care setting and/or combination in utilization management , appeals and grievances, delegation oversight , and/or CNA experience. At ... Utilization Management Nurse Specialist LVN II... Utilization Management Nurse Specialist LVN II Job Category: Clinical...- $107,498.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by the… more
- Intermountain Health (Murray, UT)
- …evaluation, and innovative management of Select Health's Health Services care management and utilization management programs. Programs include but are ... platform products to both target and scale operations for utilization management , care management (eg...a D-SNP product. The position will need to have oversight of the care management for these… more
- 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
- Point32Health (Canton, MA)
- …business rules; oversight of all aspects of outpatient services utilization management ; and development, implementation and refinement of effective business ... identify, plan and implement Point32Health strategic expansion initiatives, utilization management and/or clinical operations strategies. + Represent… more
- Molina Healthcare (NV)
- …statistics including plan utilization , staff productivity, cost effective utilization of services, management of targeted member population, and triage ... this time.** **Prior experience with managed care (Medicaid, Medicare) Utilization Management processes and 3 + years.... + Minimum 2 years of healthcare or health plan supervisory or managerial experience, including oversight … more
- LA Care Health Plan (Los Angeles, CA)
- …acts as a liaison between the Plan Partners, PPGs and Vendors regarding Utilization Management (UM) issues; assists in improving access and utilization ... is responsible for ensuring that delegates contracted to perform Utilization Management (UM) functions on behalf of...Department. This position is responsible, as part of the oversight team, for ensuring compliance of the Plan… more
- Humana (Jefferson City, MO)
- …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
- AdventHealth (Altamonte Springs, FL)
- …Informs and assists providers to ensure appropriate documentation exists to support the care management plan for the patient. . Provides feedback and advice to ... Utilization will oversee ED, Inpatient, and Specialist utilization , and manage care management outcomes. The...oversight and implementation of the chronic disease Care Management (CM) programs within the practices. The Senior Manager… more
- Dignity Health (Bakersfield, CA)
- …practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment, ... Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid...Minimum of 10 years+ of clinical experience in a Utilization Management setting preferred - Board Certified… more
- Humana (Louisville, KY)
- …of medical services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan . The Utilization Management Nurse 2 work assignments ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...-6:00 PM Eastern Time with rotating on-call coverage and oversight during weekends and holidays. **Use your skills to… 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
- 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
- Dartmouth Health (Lebanon, NH)
- Overview The Manager of Utilization Management is responsible for day to day operations of the utilization review program at multiple Dartmouth Health system ... reimbursement. * We have a very popular "earned time" plan . * We have extensive CEU/Training programs. * Our...related to patient status. * Assumes responsibility for the oversight of in bed denials, including, but not limited… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- …United States Office of Personnel Management 's website at https://www.opm.gov/policy-data- oversight ... Summary The Supervisory Acquisition Utilization Specialist serves as a liaison and advisor...support services required by project managers, program managers, upper management and stakeholders on all aspects of procurement for… more
- Molina Healthcare (Los Angeles, CA)
- …, NCQA, CMS and State Medicaid entities. **Job Duties** + Oversees Utilization Management , Claims, Organizational Credentialing, and Crisis Call Center delegated ... Administrative Service Organization for monitoring and auditing of Crisis Lines, Utilization Management , and Organizational Credentialing. + Ensure that all… 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
- 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
- Point32Health (MA)
- …recommendations to improve outcomes of assigned services such as CM and UM ( Utilization Management ). The Clinical Program Manager works directly and regularly ... and identify system wide issues. + May develop and administer programs/processes changes, and oversight management of ongoing program and processes. + Acts as a… more