- Cleveland Clinic (Cleveland, OH)
- …career with one of the most respected healthcare organizations in the world. As a Utilization Management Specialist , you will perform UM activities, such as ... discharge plan. + Achieve a minimum of 85% on IRR quarterly. + Complete Utilization Management for assigned patients with a minimum of 25-30 reviews per day. +… more
- Penn State Health (Hershey, PA)
- …status, and family medical or genetic information._ **Union:** SEIU Healthcare Pennsylvania **Position** Utilization Management Specialist - Utilization ... responsible for maintaining compliance with the CMS Conditions of Participation for Utilization Management . MINIMUM QUALIFICATIONS: * Bachelors Degree in Nursing… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- Alameda Health System (Oakland, CA)
- … + Req #:41829-30986 + FTE:1 + Posted:April 10, 2025 **Summary** **SUMMARY:** The System Utilization Management Specialist (UMS) will play a pivotal role in ... System Utilization Management SUM Specialist + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Care … 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 ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Sanford Health (Sioux Falls, SD)
- …Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to ... potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality...in monitoring the utilization of resources, risk management and quality of care for patients in accordance… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Utilization Management Specialist , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: ... to be named a Forbes "Best Employer" seven times. Position Summary: The Utilization Management Specialist I will perform utilization management … 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 ... including UM Operations, and UM Clinical. The UM Operations Specialist is expected to have strong computer skills, the...documents meeting minutes Under the supervision of the Director, Utilization Management (UM) Operations & Member Services,… more
- Sharp HealthCare (San Diego, CA)
- …and employer business practices. **What You Will Do** The Provider Relations Specialist is responsible for the development and maintenance of positive working ... Qualifications** + Bachelor's Degree Business, marketing, or health care management . **Other Qualification Requirements** + Utilizes reliable transportation and… more
- Hackensack Meridian Health (Hackensack, NJ)
- …a. Provides direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight for accurate patient ... Physician Utilization Review Specialist Per Diem HUMCHACKENSACK...vs. Inpatient c. Liaison to the Medical Staff supporting Utilization Management Committee processes d. Hospital Based… more