- University of Maryland Medical System (Lake Arbor, MD)
- …maintain employee/ supervisor relationships, and also assists in balancing time management for nurse manager. Assistant Manager is on-point to provide on-site ... identified outcomes.Effectively participates in the development, communication, monitoring and management of personnel on the unit. Effectively incorporates patient… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor , Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... 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… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... standards and federal/state regulations and general principles relating to utilization review. + Computer skills, including Microsoft Office programs. +… more
- UCLA Health (Los Angeles, CA)
- …Advantage team, you will be responsible for assisting with the day-to-day management of the UM department and coordinators. This will involve coordinating staff ... schedules to efficiently handle incoming referrals and phone call volume. You will develop workflows, desktop procedures, forms, training materials, and protocols for achieving team objectives and key performance indicators. You will hire and train… more
- Centene Corporation (Atlanta, GA)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- SSM Health (MO)
- … of daily operations within assigned region(s) or ministries related to the Utilization Management (UM) Review area under the direction of managers. Interacts ... Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES + Responsible for daily Utilization Management (UM) operations, which includes referrals, medical… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …requests for specific services. Under the supervision of the Health Service Supervisor , the Utilization Management Representative is primarily responsible ... **Responsibilities** The Utilization Management Representative (UMR) provides office support for all units within the Utilization Management and/or… more
- Centene Corporation (Tallahassee, FL)
- …to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... adherence to performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH care member issues related to BH… more
- Hartford HealthCare (Wethersfield, CT)
- …Resource Management Associate's focus is on providing support and coordination of utilization management services for the utilization management ... department. *_Position Responsibilities:_* 1. Monitors and manages assigned utilization management reports, including the Payer End of Day report, Utilization… more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical ... service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role...requirements are met + Additional duties as requested by supervisor + Maintains knowledge of CMS, State and NCQA… more
- Sharp HealthCare (San Diego, CA)
- …with patient care team members to help maintain cost effective drug utilization and formulary management .Assists other healthcare team members in keeping ... pharmacy team members, and payers to ensure appropriate reimbursement and drug utilization . This member is expected to work effectively and constructively with all… more
- BayCare Health System (Cotton Plant, AR)
- …and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and compassionate team. ... **The Utilization Review Specialist Senior responsibilities include:** + Functions as...services + Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials.… more
- CVS Health (High Point, NC)
- …training, position is remote with occasional in office requirement.** Utilization Review - Precertification Nurse is responsible for telephonically assessing, ... planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall… more
- Commonwealth Care Alliance (Boston, MA)
- …and facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS… more
- Kepro (Minneapolis, MN)
- …partner for health solutions in the public sector. Acentra is looking for a Utilization Management - Mental Health Clinical Reviewer to join our growing team. ... meet the workload demands of the department. + In collaboration with Supervisor , responsible for the quality monitoring activities including identifying areas of… more
- Hartford HealthCare (Torrington, CT)
- …Summary* Under the Direction of the Inpatient Nurse Director & Social Work Supervisor , the Inpatient Psychiatric Utilization Review Social Worker will work ... collaboratively with the IP Psychiatry Patient Care Team to assure Utilization Review activities on a 17 bed Adult unit. The Care Manager will liaison with insurance… more
- Veterans Benefits Administration (Washington, DC)
- Summary The incumbent serves as an Acquisition Utilization Specialist. The incumbent serves as an Acquisition Utilization Specialist in the Acquisition ... requirements for the Office of Acquisition. Managing the Acquisition Human Capital Management Logistics Office (ACMLO). Aiding in facilitating training for all VBA… more
- The Cigna Group (Bloomfield, CT)
- …regarding Medicare appeals and related issues, implications and decisions. The Case Management Analyst reports to the Supervisor /Manager of Appeals and will ... but not limited to:** + Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C + Ability to differentiate… more
- WellSpan Health (York, PA)
- …peer cases for need of retrospective external appeal-and funnel those cases to the Supervisor of Utilization Management for expedition. + Reviews cases ... Management staff. Duties and Responsibilities Essential Functions: + Renders utilization management determination in accordance with State and Federal… more
- WellSpan Health (York, PA)
- … Management in the provision of leadership and integration of utilization management principles throughout the Hospital. Duties and Responsibilities Essential ... Supervisor - Case Management Location: WellSpan...as required. + Develops and initiates educational programs regarding utilization management principles and CM when needed.… more
