- Humana (Louisville, KY)
- **Become a part of our caring community and help us put health first** The Associate Director , Utilization Management utilizes clinical nursing skills to ... documentation and communication of medical services and/or benefit administration determinations. The Associate Director , Utilization Management Nursing… more
- Ascension Health (Nashville, TN)
- …TN market. Must be located with in the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role, ... **Details** + **Department:** Utilization Management + **Schedule:** Monday -...optimize patient care and partner with the National Senior Director of UM to align on organizational goals. Ready… 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: Full ... safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- AmeriHealth Caritas (Newtown Square, PA)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... policies. When necessary, cases are escalated to the Medical Director for further review. The reviewer independently applies medical...in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon… more
- Rady Children's Hospital San Diego (San Diego, CA)
- JOB SUMMARY: Under the supervision of the Director , Utilization Management (UM) Operations & Member Services, the UM Operations Specialist will provide ... and documents meeting minutes Under the supervision of the Director , Utilization Management (UM) Operations...Excellent keyboard skills including numbers and accuracy of entries. Associate 's Degree or Bachelor's Degree can be accepted in… more
- Vanderbilt University Medical Center (Nashville, TN)
- …Operating Officer - Vanderbilt Transplant Center. The Executive Director and Associate Operating Officer shall provide general management for the operations ... Director and Associate ...+ Lead activities related to performance, improvement, and risk management programs to establish and meet clinical quality goals,… more
- CVS Health (Austin, TX)
- …Must be wiling and able to work Monday through Friday 8:00am to 5:00pm CST. Utilization Management is a 24/7 operation, and the work schedule will include ... and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with… more
- University of Florida (Gainesville, FL)
- … Professor. The Assistant Director for Clinical Services assists the Associate Director for Clinical Services in providing leadership, vision, coordination, ... and oversight for clinical services and operations. They are responsible to the Director or Associate Director of Clinical Services or appropriate… more
- AmeriHealth Caritas (Charleston, SC)
- …**Responsibilities:** Under the direction of the Supervisor, the Behavioral Health Utilization Management Reviewer is responsible for completing medical ... and appropriately identify and refer requests to the Medical Director when indicated. The BH UM Reviewers are responsible...of behavioral health and substance use disorder experience.; + Utilization management experience in a managed care… more