- Dignity Health (Phoenix, AZ)
- …**Responsibilities** **This role is for the Arizona and Nevada markets.** The Utilization Management (UM) Manager is responsible for managing day-to-day UM ... necessity determinations; processes appeals and reconsiderations. Act as a working manager within Utilization Management, performing essential duties and… more
- Catholic Health Initiatives (Lexington, KY)
- …1. Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted ... for appropriate status determination. 2. Ensures compliance with principles of utilization review , hospital policies and external regulatory agencies, Peer… more
- Huron Consulting Group (Chicago, IL)
- …will be fully internal. This role is a Manager or Sr. Manager . Responsibilities: 50% Utilization * Oversee activities supporting persona: * Utilization ... you are now and create your future. The Talent Utilization Coordinator will serve as the lead for managing...to conduct initial reviews of pricing tools from Risk Review , ensuring that all pricing strategies are viable and… more
- Dignity Health (Santa Maria, CA)
- …Abilities, and Training** * Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used * Proficient in application of clinical ... womens services. **Responsibilities** **JOB SUMMARY / PURPOSE** Responsible for the review of medical records for appropriate admission status and continued… more
- Humana (Jefferson City, MO)
- …part of our caring community and help us put health first** The Manager , Utilization Management Behavioral Health utilizes behavioral health knowledge and skills ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Behavioral Health works within specific… 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 Type: Full ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically… more
- Elevance Health (Richmond, VA)
- **Title: Utilization Management Representative I** **Location:** This position will work a remote model. Ideal candidates will live within 50 miles of one of our ... PulsePoint locations. The ** Utilization Management Representative I** will be responsible for coordinating...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Elevance Health (Louisville, KY)
- **Title: Utilization Management Representative II** **Location:** This position will work a remote model. Ideal candidates will live within 50 miles of one of our ... PulsePoint locations. The ** Utilization Management Representative II** will be responsible for managing...provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for… more
- AON (Cleveland, OH)
- Aon is Looking for Senior Broker- Middle Market As part of an industry-leading team, you will help empower results for our clients by delivering innovative and ... group. As a Senior Broker, you will report directly to the Pacific Southwest Middle Market Practice Leader. This is a hybrid role working from our Irvine, CA office.… more
- HCA Healthcare (Austin, TX)
- …Healthcare we support our colleagues in their positions. Join our Team as a Case Manager Austin Market Float Pool and access programs to assist with every stage ... certifications and job skills. Apply today for our Case Manager Austin Market Float Pool opening and...supporting a balance of optimal care and appropriate resource utilization . Market Float Pool employees will be… more