- VNS Health (Manhattan, NY)
- …of VNS Health Plans Medical Management clinical and non clinical staff. Makes recommendations to the development, utilization , and evaluation of internal ... OverviewSupervises and coordinates the day-to-day business operations of clinical and non clinical support activities, including monitoring internal processes,… more
- AmeriHealth Caritas (Newtown Square, PA)
- …www.amerihealthcaritas.com. **Responsibilities:** Under the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates ... quality benchmarks, and efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon to: +… more
- AdventHealth (Tampa, FL)
- …**The role you'll contribute:** Under general direction of the Manager of Utilization Management , supervises all functions of ensuring complete and accurate ... operations of working accounts, payments, denials, auth correspondence and clinical requests as appropriate. Responsible for all insurance authorization outcomes… 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 ... net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM)...in Nursing Experience Required: Minimum of 7 years of acute/ clinical care experience. Minimum of 2 years of experience… more
- Centene Corporation (Phoenix, AZ)
- …to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH… more
- Spectrum Billing Solutions (Skokie, IL)
- …cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing team. The UR Supervisor ... to staff in handling escalations and/or issues. + Review patient admission and clinical information to ensure medical necessity and compliance of utilization … 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 ... and key performance indicators. You will hire and train non- clinical coordinator staff as well as manage and monitor...We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to ... staff, members and providers. + Provides backup for the Supervisor , whenever necessary. Participates in the orientation of new...Bachelors degree preferred. + Minimum of three years of clinical experience required. Utilization Management … more
- Stanford Health Care (Palo Alto, CA)
- …practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, ... - 5+ years of experience as an RN - 3+ years of experience in case management / utilization review Why work at Stanford Medicine | Stanford Health Care (SHC)? -… more
- Catholic Health Services (Melville, NY)
- …Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and appeals functions to include coordination of ... payment related activities. Position Responsibilities: | Prepares necessary documentation for utilization management and appeals processes, performs data … more