- Penn Medicine (Princeton, NJ)
- …day. Are you living your life's work? Schedule: Full Time Summary: Conducts Utilization Management reviews for Princeton House patients, assigned by the ... in the SQL Database as per department policies and procedures. Conducts Utilization Management reviews for assigned patients, regardless of their insurance,… more
- AmeriHealth Caritas (Newtown Square, PA)
- …**Responsibilities:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity ... times, quality benchmarks, and efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon… more
- AmeriHealth Caritas (Charleston, SC)
- …. **Responsibilities:** Under the direction of the Supervisor, the Behavioral Health Utilization Management Reviewer is responsible for completing medical ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer...of behavioral health and substance use disorder experience.; + Utilization management experience in a managed care… more
- Monroe Plan for Medical Care (Albany, NY)
- …to work independently.-Strong organizational skills.-Strong computer and typing skills PREFERRED: -Prior Utilization Review or Case Management preferred. ... Utilization Reviewer RN Summary Title: Utilization... RN ID:UM41-ALBANY Location:Albany Job Type:Full-time Date Posted:04/17/2025 Openings:1 Department: Utilization Management Description Looking for meaningful work… more
- Baptist Memorial (Jackson, MS)
- Overview Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness of healthcare services and treatment as ... prescribed by utilization review standards. The UR Nurse works...management , medical necessity reviews, verification of authorization, resource utilization , and denial prevention. Responsibilities + Completes and enters… 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Conduct pre-certification, concurrent, and retrospective reviews with emphasis on utilization management , discharge planning, care coordination, clinical ... NCQA requirements. + Refer to RN or PT Clinical Utilization reviewer for more complex cases as...(Inpatient, outpatient, or skilled nursing levels of care). + Utilization Management experience preferred + Active licensure… more
- The Cigna Group (Bloomfield, CT)
- …Summary** Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluates appropriate health care ... to facilitate appropriate healthcare outcomes for members. Ensures that case management program objectives are met by evaluating the effectiveness of alternative… more
- Wellpath (Lemoyne, PA)
- …care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review , case management , ... and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and… more
- Magellan Health Services (Honolulu, HI)
- …Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community ... other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided...Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience -… more