- Dignity Health (Bakersfield, CA)
- …review based on medical necessity. The position partners with both the Pre - Service and In-Patient Utilization Management teams. Ensures to monitor and ... Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full- service management service organization structure. We offer a… more
- Dignity Health (Bakersfield, CA)
- …review based on medical necessity. The position partners with both the Pre - Service and In-Patient Utilization Management teams. Ensures to monitor and ... Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full- service management service organization structure. We offer a… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Dignity Health (Rancho Cordova, CA)
- …the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for coordination of ... sets (Medicare Guidelines InterQual Health Plan Benefit Interpretation Guidelines and Medical Management Policies and DHMF Utilization Management guidelines… 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 ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...UM Manager and Physician Advisor on case reviews for pre - service , concurrent, post- service and retrospective… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team of UM ... for overseeing and coordinating the following major functions: + Pre - service Authorizations/Denial Letters + Concurrent Review +...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- Hackensack Meridian Health (Hackensack, NJ)
- … Management Criteria ( ie MCG, Xsolis) b. Supports & Participates in pre -admission review, utilization management , and concurrent and retrospective review ... a. Provides direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight for accurate patient… more
- Hackensack Meridian Health (Hackensack, NJ)
- … Management Criteria ( ie MCG, Xsolis) b. Supports & Participates in pre -admission review, utilization management , and concurrent and retrospective review ... a. Provides direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight for accurate patient… 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
- System One (Baltimore, MD)
- …teams by assisting with non-clinical administrative tasks and responsibilities related to pre - service , utilization review, care coordination and quality of ... IT Services is staffing a contract to hire opportunity for a Utilization Management Coordinator to support a leading health insurance customer. The individual… more