- UCLA Health (Los Angeles, CA)
- …culture. You can do all this and more at UCLA Health. In this role as a Utilization Review Supervisor within our utilization department you would be ... services within NPH. This role entails overseeing a team of utilization review nurses, ensuring compliance with clinical regulatory standards, and enhancing the… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the… more
- Centene Corporation (Madison, WI)
- …anywhere within the continental US. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical 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… more
- Veterans Affairs, Veterans Health Administration (San Francisco, CA)
- Summary The Patient Flow Utilization Management/ Utilization Review Consultant RN functions with advanced knowledge and skills to provide clinical ... with a collaborative, inter-disciplinary practice setting. Responsibilities The Patient Flow Utilization Management/ Utilization Review Consultant RN is… more
- BayCare Health System (Cotton Plant, AR)
- …responsibility 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:** +...services + Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials.… more
- CareFirst (Baltimore, MD)
- …accreditation standards and federal/state regulations and general principles relating to utilization review . + Computer skills, including Microsoft Office ... **Resp & Qualifications** **PURPOSE:** Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of… more
- Hartford HealthCare (Torrington, CT)
- …*Job 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… more
- CDS Life Transitions (Webster, NY)
- …as assigned by supervisor . + Acts as Subject Matter Expert in Utilization Review and medical necessity criteria + Continually maintain clear, effective ... Summary: Utilization Management Reviewer (UR) is the critical evaluation...and medical necessity of those services + Compile and review the necessary documents and clinical records to effectively… more
- Commonwealth Care Alliance (Boston, MA)
- …service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS ... 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… more
- Commonwealth Care Alliance (Boston, MA)
- …Reviewer is responsible for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Utilization Management ... Be Doing:** **Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical… more
- Commonwealth Care Alliance (Boston, MA)
- …service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS ... 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… more
- Kepro (Indianapolis, IN)
- …for health solutions in the public sector. Acentra is looking for a BCBA Utilization Reviewer to join our growing team. Job Summary: The purpose of this position ... is to utilize clinical expertise to review medical records for Applied Behavioral Analysis against appropriate criteria in conjunction with contract requirements,… 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. This ... The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements,… more
- CVS Health (New Albany, OH)
- …Following training, position is remote with occasional in office requirement.** Utilization Review - Precertification Nurse is responsible for telephonically ... innovators. **Fundamentals:** Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit plan eligibility… more
- Kepro (Chicago, IL)
- …Supervising and managing the day-to-day activities of the assigned case management and utilization review teams. . Mentoring, coaching, and training team members ... in the public sector. Acentra seeks a Clinical Operations Supervisor - RN (Remote US) to join our growing...Supervises, mentors, coaches, trains, and develops the: o Case review and utilization review teams… more
- Louisiana Department of State Civil Service (Tallulah, LA)
- …of subordinate nurses engaged in quality assurance, infection control, and utilization review activities. Receives physicians' instructions regarding patient ... Registered Nurse Supervisor A Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4646362) Apply Registered Nurse Supervisor A Salary… more
- WellSpan Health (York, PA)
- …with the CM leadership team in developing and maintaining CM policy including, Utilization Review , Social Services and Clinical Case Management. + Identifies ... Supervisor - Case Management Location: WellSpan Health, York,...Management in the provision of leadership and integration of utilization management principles throughout the Hospital. Duties and Responsibilities… more
- CN (Pokegama, MN)
- …because the work we do matters. Join us! **Job Summary** The Transportation Supervisor is an entry-level front line supervisor position responsible for meeting ... and in compliance with governing regulations and CN's operating rules. The Transportation Supervisor may also be an on-call position that reports to remote locations… more
- Children's Aid (Staten Island, NY)
- Social Work Supervisor (FFT) 8/9/24Full Time--Staten Island Job ID: 007217 Description: Goodhue Community Center (304 Prospect Avenue) $72,000 - $78,000 Sign-On ... Bonus Eligible **Position Summary:**The**Functional Family Therapy (FFT) Supervisor **in our Family Assessment Program (FAP) will serve the combined roles of an… more
- Louisiana Department of State Civil Service (Reserve, LA)
- …of subordinate nurses engaged in quality assurance, infection control, and utilization review activities. Receives physicians' instructions regarding patient ... REGISTERED NURSE SUPERVISOR A Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4653654) Apply REGISTERED NURSE SUPERVISOR A Salary… more